不同部位上消化道黏膜下肿瘤临床特征及治疗方法

Clinical characteristics and treatments for upper gastrointestinal submucosal tumors located in different sites

目的:探讨上消化道不同部位黏膜下肿瘤的临床特征及治疗方法.方法:收集159例上消化道不同部位黏膜下肿瘤患者,行内镜下黏膜剥离术(endoscopic submucosal dissection,ESD)切除病灶,切除后病灶均送病理,比较不同部位性别及年龄组成比,病灶最大直径,手术时间及并发症发生率,所有患者2 mo及6 mo后复查胃镜.结果:159例患者中,病灶位于食道28例,贲门12例,胃底44例,胃体48例(其中2例为残胃),胃窦22例,十二指肠5例.病灶完全切除155例(155/159,97.5%),术中病灶行整块切除154例(154/159,96.9%),食道者16例以隧道法切除,胃底者16例行全层切除.病灶位于食道者,隧道法及普通ESD术手术时间相比差异无统计学意义.病灶位于胃底者,普通ESD术及全层切除法手术时间相比差异无统计学意义.术后病理主要包括平滑肌瘤、间质瘤及异位胰腺.本研究中共发生术中穿孔19例,后均行全层切除术,成功闭合创面;所有术中出血均以电凝止血钳及钛夹成功止血,术后迟发性出血发生2例,均经急诊内镜下钛夹成功止血.所有患者术后2 mo及6 mo复查胃镜,所有患者创面愈合良好,未见复发.结论:上消化道黏膜下肿瘤根据其不同生长部位,有其不同临床及病理特征,可采用不同ESD手术方式.

AIM：To investigate the clinical characteristics and treatment methods for upper gastrointestinal submucosal tumors located in different sites.METHODS：One hundred and fiftynine patients with upper gastrointestinal tract submucosal tumors were included.Endoscopic submucosal dissection（ESD）was performed,and the resected lesions were subjected to pathological examination.Gender and age composition ratio,maximum diameter of lesions,operation time and the rate of complications were compared among tumors located in different sites.All patients underwent gastroscopy two and six months after operation.RESULTS：There were 28 lesions in the esophagus,12 in the cardia,44 in the gastric fundus,48 in the gastric body（including 2cases of residual stomach）,22 in the gastric sinus,and 5 in the duodenum.Complete resection was performed in 155（155/159,97.5%） cases,and 154 cases were resected as a whole piece（154/159,96.9%）.In the esophagus,16 cases were resected by submucosal tunneling endoscopic resection;in the gastric fundus,16 cases were resected by endoscopic filtering resection.There was no significant difference in operation time between submucosal tunneling endoscopic resection and ordinary ESD for tumors in the esophagus.There was also no significant difference in operation time between endoscopic filtering resection and ordinary ESD for tumors in the gastric fundus.The pathologic diagnoses mainly included leiomyoma,stromal tumors and ectopic pancreas.The major complications were perforation,intraoperative bleeding and postoperative delayed bleeding.A total of 19 cases developed perforation and underwent endoscopic filtering resection to close the wound successfully.Intraoperative bleeding was managed successfully with electric coagulation forceps and titanium clip in all patients.The two cases with postoperative delayed bleeding were managed successfully by emergency endoscopic titanium clipping.All patients underwent gastroscopy after two and six months,which revealed that the wound healed well,and no recurrence occurred.CONCLUSION：Upper gastrointestinal submucosal tumors located in different sites show different clinical and pathological features,and different ESD operation methods should be selected.