常见消化道黏膜下肿物的临床特点及治疗方法

Clinical Characteristics and Treatment Methods for Common Gastrointestinal Submucosal Tumors

目的:探讨常见消化道黏膜下肿物(submucosal tumors,SMTs)的临床特点、治疗方式及安全性。方法:选择2014年5月至2016年3月在哈医大一院经内镜切除的并经病理及免疫组化明确诊断的消化道粘膜下肿物的患者共49例。所有患者术后3个月、6个月及12个月后随诊复查胃镜。统计每种肿物的患者临床症状,各种黏膜下肿物的性别分布、大小,及在消化道的分布。计算超声内镜的诊断率,总结病理结果。结果:49例患者中,间质瘤25例,类癌9例,平滑肌瘤8例,异位胰腺4例,脂肪瘤2例,颗粒细胞瘤1例。间质瘤分布以胃底、胃体多见。类癌以直肠最多见,胃内也可见。平滑肌瘤多分布于食管,也可见于胃。异位胰腺多分布于胃窦。通过内镜黏膜下挖除术(Endoscopic submucosal excavation,ESE)切除42例,粘膜下隧道切除术(Submucosal tunneling endoscopic resection,STER)切除4例,还有3例行内镜下黏膜切除(Endoscopic Mucosal Resection,EMR)。所有患者术后均无迟发性出血、严重感染及死亡病例发生。随访3-22个月,所有患者均无复发。结论:黏膜下肿物在内镜及超声内镜各有特点。超声内镜对黏膜下肿物的诊断与治疗具有重要的指导意义。双镜联合使SMTs的内镜下各种治疗方式(EMR、ESE、STER)更有安全保障,使患者受益最大。

Objective： This study is to explore the clinical features of common gastrointestinal submucosal lesions, treatments and its safety. Methods： 49 patients with submucosal tumors approved by endoscopic resection from May 2014 to January 2016 at the First Clinical Hospital affiliated to Harbin Medical University were pathologically diagnosed and enrolled. All patients underwent endoscopy during follow-up period of three, six and twelve months after operation. Clinical symptoms of each patient, gender distribution, size and distribution of various kinds of submucosal lesions in the digestive tract were counted. Diagnostic rate of EUS and immunohistochemical results were also summarized. Results： The diagnosis of 49 cases of gastrointestinal submucosal tumor was 25 cases of gastrointestinal stromal tumor, 9 cases of carcinoid, 8 cases of gastrointestinal leiomyoma, 4 cases of heterotopic pancreas, 2 cases of lipoma and 1 case of granular cell tumor. GIST was mainly distributed in the bottom and body of the stomach. Carcinoid was seen most frequently in rectum, and also visible in the stomach. Leiomyoma was more common in the esophagus, also seen in the stomach. Heterotopic pancreas appears mostly in gastric antrum. 42 cases of submucosal tumor were resected by ESE, 4 cases by STER and 3 cases by EMR. There were no delayed bleeding, severe infection and death occurred in these cases. During the postoperative follow-up period of 3 to 22 months, all patients had no recurrence. Conclusions： Submucosal lesions have their own characteristics under endoscope and endoscopic ultrasonography. EUS has an important guiding role on the diagnosis and treatment of submucosal neoplasm. Endoscopy combined with laparoscopy make endoscopic treatments like ESD, ESE, STER become much safer and benefit patients most.