消化系炎性纤维性息肉内镜微创诊治分析

Minimally invasive diagnosis and treatment of digestive inflammatory fibrous polyps

目的探讨消化系炎性纤维性息肉(inflammatory fibrous polyps,IFP)的临床、病理及内镜下特点,评价内镜微创治疗的效果及安全性。方法回顾性分析22例消化系IFP患者的临床、病理及内镜资料,其中经内镜微创治疗20例,观察不良反应及复发情况。结果22例IFP患者中,男8例,女14例,年龄(52.73±10.96)岁(27~71岁),病灶多为单发,部位以胃窦为主,病灶直径(1.71±1.04)cm,最大直径4.5 cm。典型病理表现为梭形细胞增生,伴嗜酸性粒细胞浸润,围绕血管形成"洋葱皮样"结构,Vimentin、CD34多呈阳性表达。普通内镜下多表现为息肉样隆起,超声内镜(ultrasound endoscopy,EUS)下多表现为黏膜肌层或黏膜下层低回声改变,内部回声尚均匀,边界欠清。本组行内镜微创治疗20例患者共21个IFP病灶,其中内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)14个,内镜下黏膜切除术(endoscopic mucosal resection,EMR)3个,高频电凝电切术4个。1例起源于胃固有肌层的IFP行ESD手术出现术中出血,量约150 ml,内镜下止血成功,其余患者均未发生术中及术后迟发型出血、穿孔等并发症。2例行外科手术治疗,其中1例为小肠IFP合并右半结肠腺癌,另1例由于病灶巨大,术前怀疑有恶变倾向,行外科手术治疗,术后病理诊断为胃IFP。随访4~38个月,失访2例,死亡1例,其余患者均无复发。结论消化系IFP好发于中老年,女性居多,病灶以胃窦为主,普通内镜及EUS对IFP有一定诊断价值,确诊依赖病理组织检查,大部分IFP经内镜微创治疗安全、有效。

Objective To investigate the clinical,pathological and endoscopic features of digestive inflammatory fibrous polyps(IFP)and evaluate the efficacy and safety of endoscopic minimally invasive treatment.Methods The clinical,pathological and endoscopic data of 22 patients with IFP in the digestive system were retrospectively analyzed.Among them,20 patients underwent minimally invasive endoscopic treatment to observe adverse reactions and recurrence.Results Of the 22 patients with IFP,8 cases were male and 14 cases were female,aged(52.73±10.96)years old(27-71 years old).The lesions were mostly single,and the lesions were mainly antrum.The diameter of the lesion was(1.71±1.04)cm and the maximum diameter was 4.5 cm.The typical pathological manifestation was spindle cell hyperplasia with eosinophil infiltration,forming an"onion skin-like"structure around the blood vessels,and Vimentin and CD34 were mostly positive.Under normal endoscopy,polypoid bulge was often manifested.Ultrasound endoscopy(EUS)was characterized by hypoechoic changes in the mucosal muscle layer or submucosa.The internal echo was still uniform and the boundary was not clear.This group underwent endoscopic minimally invasive treatment of 20 cases of 21 IFP lesions,including 14 endoscopic submucosal dissection(ESD),3 endoscopic mucosal resection(EMR),and 4 high-frequency electrocoagulation.One case of IFP originating from the natural muscular layer of the stomach showed intraoperative hemorrhage with an intraoperative hemorrhage of about 150 ml.Endoscopic hemostasis was successful.No other patients had complications such as intraoperative and postoperative delayed bleeding and perforation.2 cases of surgical treatment,one case was small intestine IFP combined with right colon adenocarcinoma,and the other one was due to a large lesion,preoperative suspected malignant tendency,surgical treatment,postoperative pathological diagnosis of gastric IFP.The follow-up ranged from 4 months to 38 months.Two patients were lost to follow-up and one patient died.The other patients had no recurrence.Conclusion The IFP of digestive system occurs in middle-aged and elderly people.Most of them are female,and the lesions are mainly gastric antrum.The common endoscopy and EUS have certain diagnostic value for IFP.The diagnosis depends on pathological examination.Most IFP is safe and effective by endoscopic minimally invasive treatment.