内镜下黏膜剥离术治疗胃钙化纤维性肿瘤4例临床分析

Clinical analysis of endoscopic submucosal dissection for 4 cases of gastric calcifying fibrous tumors

目的探讨胃钙化纤维性肿瘤（calcifying fibrous tumor，CFT）的内镜下特点及内镜下黏膜剥离术（endoscopic submucosal dissection，ESD）治疗胃CFT的临床疗效。方法回顾性分析2015年1月-2015年7月于武汉大学人民医院消化内镜中心行ESD治疗的260例患者病理结果及其中4例CFT的临床资料（包括消化内镜、超声内镜、ESD治疗及随访情况）。结果4例CFT患者中，平均年龄（48．75±9．14）岁，临床无特异性表现。4例CFT患者病灶均为单发，大小0．6～2．5cm。超声内镜特点为起源于固有肌层的低回声病灶。4例患者均行ESD治疗，病灶均完整切除，病理主要为纤维结缔组织中夹杂少量纤维母细胞及散在的砂砾体形成；免疫组织化学显示纤维母细胞Vimenti阳性。术后无出血、穿孔等并发症，随访半年无复发。结论胃CFT以单发表现，中老年常见，内镜下ESD治疗胃CFT安全、有效，可一次性完整切除病灶，术后并发症少，复发率较低。

Objective To investigate the endoscopic performance and features of the calcifying fibrous tumor （CTF） , and evaluate the value of endoscopic submucosal dissection （ESD） treatment for it. Methods A total of 4 gas- tric CFT who were treated with ESD the endoscopic center of Renmin Hospital, Wuhan University from Jan. 2015 to Jul. 2015 were retrospectively analyzed. Endoscopic ultrasound （EUS） was used to assess whether endoscopy treatment was suitable. Tumor characteristics, complications, the enbloc resection rate, and the local recurrence rate were evalua- ted. Results Of the 4 patients, the median age was （48.75 ± 9.14） years old. The maximum size of the lesions was from 0.6 cm to 2.5 era. The EUS features of the lesions included a mass in the muscularis propria of the gastric wall and a heterogeneous hypoechoic. All of the endoscopic treatments were completed successfully. The enbloc resection rate was 100%. Confirmed diagnosis was made by pathologic results. No local recurrence or complications were observed during the follow-up period （ranging from 6 to 8 months）. Conclusion ESD treatment appears to be a feasible and safe proce- dure for CFT with relatively few complications and low mortality.