食管黏膜下肿物的特性以及超声内镜的诊断和治疗意义

Characteristics of Esophageal Submucosal Tumor and Significance of Endoscopic Ultrasonography in Diagnosis and Treatment of Esophageal Submucosal Tumor

背景:食管病变内镜下或手术治疗的风险均较高,术前准确判断病变的层次和性质,对决定手术的方式十分重要。目的:探讨食管黏膜下肿物的特性以及超声内镜对食管黏膜下肿物的诊断、治疗意义。方法:由内镜检查发现的116例食管黏膜下肿物患者行超声内镜检查,并给予相应的切除治疗,总结超声内镜下食管黏膜下肿物的特性。结果:超声内镜下88例(75.9%)食管黏膜下肿物的直径<1 cm,104例(89.7%)病变起源于黏膜肌层,多数(85.3%)表现为低回声或混合偏低回声的声像图。80例接受切除治疗,其中67例(83.8%)行EMR治疗,肿物直径<1 cm者占89.6%,局限于黏膜肌层占97.0%。组织病理学分析表明食管黏膜下肿物以平滑肌瘤最为常见(86.3%)。超声内镜诊断与病理诊断的符合率约为82%。结论:大多数食管黏膜肌层起源的肿物行EMR治疗简便、安全,对于较大的病灶,或起源于固有肌层者ESD仍是一种安全有效的方法。超声内镜可判断食管黏膜下肿物起源并进行定性诊断,从而指导临床合理选择黏膜下肿物的治疗方法。

Background： As the risk of operation for esophageal disease under endoscopy or surgery is rather high, it is important to decide the mode of therapy through judging the level and nature of the lesion. Aims： To investigate the characteristics of esophageal submucosal tumor and significance of endoscopic uhrasonography in diagnosis and treatment of esophageal submucosal tumor. Methods： Endoscopic uhrasonography was performed in 116 patients with esophageal submucosal tumor diagnosed by endoscopy, and appropriate resection therapy was given accordingly. Characteristics of esophageal submucosal tumor under endoscopic uhrasonography were summarized. Results： Under endoscopic uhrasonography, diameter of esophageal submucosal tumor was less than 1 cm in 88 patients （75.9%）, esophageal submucosal tumor originated from muscularis mucosae in 104 patients （ 89. 7% ）, and most （ 85. 3% ） of the esophageal submucosal tumor were of hypoechoic or mixed low echoic sonogram. Resection therapy was performed in 80 patients, of them 67 cases （83.8%） were by EMR, whose tumor diameter was mostly less than 1 cm （89.6%） or was limited to muscularis mucosae （97.0%）. Histopathological analysis showed that esophageal leiomyoma was the most common （83.8%） esophageal submucosal tumor. The coincidence rate between endoscopic uhrasonography diagnosis and pathology diagnosis was about 82%. Conclusions： For most of esophageal submucosal tumor originated from muscularis mucosae, EMR is a simple and safe resection therapy. ESD is still a safe and effective therapy for larger lesions or lesions originated from muscularis propria. Endoscopic ultrasonography is able to diagnose the origin as well as the nature of esophageal submucosal tumor, and as a result it can guide the resonable choice of treatment for esophageal submucosal tumor in clinical practice.