食管黏膜下肿瘤的内镜下诊断与治疗

Endoscopic diagnosis and treatment for patients with esophageal submucosal tumors

目的基于食管黏膜下肿瘤(SMTs)内镜检查及治疗手段,分析食管SMTs的临床病理学特征,同时评价食管SMTs内镜下诊治的安全性、经济性和有效性。方法选择2012年1月-2017年12月新疆医科大学第一附属医院收治的98例食管SMTs患者,并同时完善普通胃镜和超声内镜(EUS)检查,所有患者均接受内镜下治疗,所有切除的肿瘤均行病理学检查。结果共98例患者。其中,女55例(56.12%),男43例(43.88%)。肿瘤位于食管上段27例(27.55%),中段28例(28.57%),下段43例(43.88%),56例病例行内镜黏膜下剥离术(ESD),25例行内镜黏膜下肿瘤挖除术(ESE),12例行内镜黏膜下隧道肿瘤切除术(STER),另3例行电凝电切除术,1例孤立性纤维性肿瘤因术中发现肿瘤基底部深转为外科手术,另1例平滑肌瘤因肿瘤体积太大致内镜操作困难,中途转胸腔镜下治疗。1例神经鞘瘤,ESD术后出现气胸、胸腔积液、术后瘘及食管狭窄等并发症,1例胸腔镜下行肿瘤摘除术的平滑肌瘤,术后发生气胸和胸腔积液,另外2例出现纵隔气肿和皮下气肿,均于术后2或3 d自行好转。病理学检查及免疫组化结果证实,最常见的食管SMTs为平滑肌瘤,共90例,占所有病例91.84%。结论食管SMTs以女性多见,好发于中下段食管,病理以平滑肌瘤最为常见;应用EUS技术能够对病变性质及组织学来源进行较准确的评估;内镜下治疗食管SMTs不仅能提供完整的病理学资料,而且有效安全。

Objectives To analyze the clinical and pathological characteristics of esophageal submucosal tumors (ESMTs), and evaluate the safety, economy and efficacy of endoscopic diagnosis and therapy for ESMTs, on account of endoscopic technique. Methods 98 patients with ESMTs were selected from January 2012 to December 2017 by endoscopy and ultrasonography;they were all treated by endoscopic therapy and pathological examination was took in all removed tumors. Result In 98 cases, 55 cases are female patients, accounting for 56.12%;the tumors located at the upper third of the esophagus accounted for 27.55%(27/98), at the middle esophagus for 28.57%(28/98), at the lower esophagus for 43.88%(43/98). 56 cases were treated by endoscopic submucosal dissection, 25 by endoscopic submucosal excavation, 12 by submucosal tunneling endoscopic resection, 3 by endoscopic polypectomy, and the rest 2 were changed to surgical treatment or thoracoscopic surgery because one solitary fi brous tumor was found the basilar part was too deep during the operation and another tumor was found to be too big and difficult to dissect by endoscopy;1 schwannoma occurred post operative pleural effusion, pneumothorax, fi stula and stenosis, 1 leiomyoma treated by thoracoscopy occurred pleural effusion, pneumothorax, another 2 occurred mediastinal and emphysema subcutaneous and got better spontaneously after 2 ~ 3 days;after pathological and immunohistochemical analysis, 90 tumors were identified as esophageal leiomyoma, which were the most common ones, accounting for 91.84%. Conclusion Most ESMTs are found in female, and are commonly located at middle and lower esophagus and most of them are leiomyoma according to the results of pathological test. It can make more accurate diagnosis in terms of different origin layers and property of esophageal tumor by endoscopic ultrasonography (EUS). Endoscopic therapy is safe and effective, and meanwhile, it can provide integral pathological information.