136例食管平滑肌瘤的临床及病理特征分析

The clinical and pathological features analysis of 136 cases of esophageal leiomyoma

目的回顾性分析食管平滑肌瘤的临床特征及病理特点,以提高临床医师对该疾病的诊断水平。方法选取新疆维吾尔自治区人民医院消化科2009年3月至2014年3月的136例住院患者,均接受内镜下治疗或手术治疗并经病理证实具有完整临床病理资料的食管平滑肌瘤。回顾性分析其临床特征、内镜学表现、超声内镜、病理及免疫组化学、治疗方式及随访结果。结果食管平滑肌瘤大多无明显临床症状,年龄(51.7±11.4)岁,在食管上、中、下段均好发,胃镜下均表现为黏膜下隆起。食管平滑肌瘤超声内镜多显示为低回声病变,超声内镜与病理符合率为93.4%。病理直接诊断平滑肌瘤最多为121例。134例行免疫组化分析,神经源性标记物(SMA)和D33结蛋白(Desmin)在平滑肌瘤中有较高的表达率。确定起源于黏膜肌层或黏膜层的肿物126例行内镜下黏膜切除术(ESD),均一次性完整剥离,无术后出血、穿孔等并发症发生。起源于固有肌层的10例行手术治疗。136例中有78例完成术后1~24个月随访,均未见穿孔、出血、疼痛等并发症,也无复发迹象。结论食管平滑肌瘤的诊断需依靠超声内镜结合病理证实。ESD术治疗大多数食管平滑肌瘤安全、有效,并为某些具有早期恶性潜能的食管平滑肌瘤的发现提供了良好的条件,从而避免了开胸手术的风险。

Objective To retrospectively analyze the clinical and pathological features of esophageal leiomyoma in order to improve its diagnosis. Methods A total of 136 patients from Mar. 2009 to Mar. 2014 in the People＇s Hospital of Xinjiang Uygur Autonomous Region were treated with endoscopic resection or surgery after confirming esophageal leiomyoma by pathology,complete clinical data were selected for the study. The clinical features,endoscopic ultrasound（EUS）,pathology,immunohistochemistry,treatment and follow-up results of 136 patients with esophageal leiomyoma were analyzed retrospectively. Results Most of the cases had no obvious clinical symptoms,and the age was（51. 7 ±11. 4） years old. The leiomyoma appeared in the upper,middle or lower sections of the esophagus in the participants.Endoscopy showed submucosal lesion. The EUS of esophageal leiomyoma showed low echo lesion,and the coincidence rate of EUS and pathology was 93. 4%. Of the 136 patients,pathological diagnosis directly indicated esophageal leiomyoma in 121 cases. Immunohistochemical analysis of 134 cases showed that the neurogenic markers（SMA） and Desmin protein（D33） were highly expressed in leiomyoma. The tumors in 126 cases,which originated from the mucosa or mucosal layer,were treated with endoscopic submucosal dissection（ESD）. postoperative bleeding,perforation and other complications were not happened. Other 10 patients,which originated from the muscularis layer,were treated with surgery. No perforation,hemorrhage,pain or other complications were observed in 78 patients followed up for 1-12 months. Conclusion The diagnosis of esophageal leiomyoma depends on EUS and pathological examinations. ESD is safe and effective for most esophageal leiomyoma,and ESD can facilitate the detection of esophageal leiomyoma with early malignant potential,thereby avoiding the risk of open chest surgery.