经黏膜下隧道内镜切除术治疗食管黏膜下肿瘤5例临床分析

Submucosal Tunneling Endoscopic Resection for Esophageal Submucosal Tumors: Analysis of 5 Cases

背景:随着胃镜检查的普及和超声内镜(EUS)技术的成熟,食管黏膜下肿瘤(SMTs)的检出率逐年上升。目的:评估经黏膜下隧道内镜切除术(STER)治疗食管SMTs的疗效和安全性。方法:5例于2012年1～6月于昆山市中医医院接受STER治疗的食管SMT患者纳入研究,肿瘤经EUS和增强CT检查诊断为来源于固有肌层。对其治疗结果、并发症发生情况、近期随访结果等进行回顾性分析。结果:5个病灶均由STER一次性完整切除,病灶长径0.8～2.0 cm,黏膜切开至黏膜切口完整缝合时间为45～95 min。术后病理诊断平滑肌瘤1例,间质瘤4例,切缘均为阴性。术后无出血、穿孔等并发症发生。出院后3个月内镜复查未见病变残留、复发。结论:STER治疗来源于固有肌层的食管SMTs安全、有效,可一次性完整切除病变,提供完整的病理信息,并避免出血、穿孔等并发症,有望成为食管SMTs的主要治疗选择。

Background： With the widespread application of gastroscopy and the technical progress of endoscopic ultrasonography （EUS）, the detection rate of esophageal submucosal tumors （SMTs） is increasing in recent years. Ahns： To evaluate the efficacy and safety of submucosal tunneling endoscopic resection （STER） for esophageal SMTs. Methods： Five cases of esophageal SMT treated by STER at Kunshan Hospital of Traditional Chinese Medicine from Jan. 2012 to Jun. 2012 were enrolled. SMTs were diagnosed as originating from muscularis propria by EUS and contrast-enhanced CT. The treatment outcome, complications and short term follow-up were analyzed retrospectively. Results： All 5 lesions were resected en bloc by STER. The tumor size ranged from 0.8-2.0 cm, and the time of procedure was 45-95 min. Four SMTs were diagnosed as stromal tumors and one as leiomyoma pathologically. Both lateral and vertical resection margins were tumor- free in all cases. No postprocedure bleeding and perforation were seen. No residual or recurrent lesions were found in endoscopic follow-up 3 months after discharge. Conclusions： STER is a safe and effective approach and may provide radical cure, accurate pathological evaluation and avoid bleeding and perforation for esophageal SMTs originating from muscularis propria. It might be a promising alternative for the treatment of esophageal SMTs.