中国食管血管瘤临床特点及治疗48例

Clinical characteristics and treatment of esophageal hemangioma: Analysis of 48 cases

目的:食管血管瘤是一罕见的食管良性肿瘤.现对我国自上世纪80年代至目前为止的食管血管瘤个案报道47例及南京医科大学第一附属医院尚未报道的1例做一回顾性分析.方法:2014-01检索中国知网数据库(1978-2013),万方数据库(1982-2013),检索题名或摘要"食管、血管瘤",共检索出全国各地个案报道47例加上本院1例一共48例并对文献中人口学特征、临床症状、辅助检查、病理学诊断、治疗及预后进行分析.所得数据采用Excel软件进行汇总计算.结果:人口学特征:全国各地皆有分布,48例中男女比例约为3∶2,平均发病年龄为48.58岁±15.11岁.临床表现:常见的症状有进食异物感、吞咽困难、胸部及上腹部不适、消化系出血,另外也可表现为呼吸困难、食欲不振、乏力等.体格检查:除部分患者查体见不同程度贫血貌外,余查体未见明显异常.辅助检查:主要有内镜、食管钡餐、计算机断层扫描(computed tomography)、超声胃镜、磁共振成像(magnetic resonance imaging)等.病理学检查:海绵状血管瘤(21/48)、血管瘤(未分型,12/48)、毛细血管瘤(6/48)、静脉瘤(6/48)、混合型血管瘤(3/48).治疗方法:有31例采用外科手术治疗,5例采用内镜治疗,5例未治疗,3例具体治疗方法不详,1例采用腔内导管电凝治疗,1例采用立体定向放射治疗.预后:31例外科手术及5例内镜治疗患者,术后恢复可,其中有8例随访1-5年不等,未见复发;2例死亡;余预后不详.结论:目前对于食管血管瘤的诊断主要依赖病理,而治疗主要依赖于外科手术,但是随着内镜技术的发展,内镜下治疗可能会成为一种新的治疗手段.

AIM： To analyze the clinical characteristics and treatment of esophageal hemangioma.METHODS： We searched the China National Knowledge Infrastructure（CNKI） database（1978-2013） and Wanfang database（1982-2013） for the reported cases of esophageal heman-gioma.A total of 48 cases were included in this study,including 47 reported cases identi-fied in the literature and 1 case found at our hospital that has not yet been reported.The demographic characteristics,clinical symp-toms,auxiliary examinations,pathological diagnosis,treatment and prognosis of these cases were analyzed.RESULTS： These cases were distributedthroughout the China.The male-to-female ratio was about 3∶2,and the average age of the patients was about 48.58 years.Common symptoms included dysphagia,chest and epigastric discomfort,gastrointestinal bleed-ing,dyspnea,anepithymia,and fatigue.There were no obvious positive signs in laboratory tests except that it was characterized by dif-ferent degrees of anemia.Auxiliary examina-tions mainly included endoscopy,esophageal X-ray barium meal,CT,MRI,and ultrasonic endoscopy.Pathological examination revealed cavernous hemangiomas（21/48）,nontypeable hemangiomas（12/48）,capillary tumors（6/48）,phlebangiomas（6/48） and mixed hemangio-mas（3/48）.In addition to basic support thera-py,other treatments included surgery（31/48）,endoscopic treatment（5/48）,untreated and regular follow-up（5/48）,unknown treatment（3/48）,lumen catheter electrical coagulation treatment（1/48）,and stereotactic radiother-apy（1/48）.Postoperative recovery was good among 31 cases treated by surgery and 5 by endoscopic treatment.Of 8 cases followed for 1-5 years,no recurrence occurred,and 2 cases died.The prognosis of the patients received no treatment or unknown treatment was un-known.CONCLUSION： The diagnosis of esophageal hemangioma mainly depends on pathological diagnosis.The treatment of esophageal heman-gioma mainly depends on surgery; however,endoscopic treatment may become a new choice of treatment.