内镜治疗上消化道神经鞘瘤52例临床分析

Endoscopic therapy for upper gastrointestinal schwannoma:An analysis of 52 cases

目的探讨内镜治疗上消化神经鞘瘤的安全性和有效性。方法回顾性分析2011年1月至2016年12月复旦大学附属中山医院内镜中心接受内镜治疗,且病理学检查确诊为上消化道神经鞘瘤52例病人临床资料,分析治疗结果及术后长期随访复发转移情况。结果52例病人中,21例病变位于食管,31例位于胃。内镜下整块切除51例,整块切除率为98.1%,1例食管上胸段病变行分块切除。中位手术时间为53.5(20.0~108.0)min。51例病人中,26例接受内镜全层切除术(EFTR),11例接受内镜黏膜下挖除术(ESE)治疗,15例接受经黏膜下隧道内镜肿瘤切除术(STER)治疗,术中均未发生严重出血,且无中转手术的病例。1例(1.9%)在术后出现胸腔积液及局部肺不张,经胸腔闭式引流治疗后好转;1例(1.9%)出现术后出血,予心电监护,输血、抗感染、抑酸、止血、补液等内科治疗后好转;1例(1.9%)术后发生电凝综合征,予以禁食、输液、静脉使用抗生素等保守治疗后好转。术后中位随访时间为36(32.0~48.0)个月,随访期间均未发现复发和远处转移。结论内镜治疗上消化道神经鞘瘤具有可靠的疗效且并发症发生率低,术后病人恢复好,可作为上消化道神经鞘瘤安全有效的治疗方式。

Objective To evaluate the safety and effectiveness of endoscopic therapy in patients with upper gastrointestinal schwannoma.Methods The clinical data of 52 patients who underwent endoscopic treatment and were confirmed as having upper gastrointestinal schwannoma by pathology in Endoscopy Center and Endoscopy Research Institute,Zhongshan Hospital,Fudan University from January 2011 to December 2016 were analyzed retrospectively.The therapeutic effect and postoperative recurrence and metastases during follow up for long term were studied.Results Among the 52 cases,21 cases’lesions located in esophagus and 31 in stomach.Fifty-one cases obtained successful complete resection,and the complete resection rate was 98.1%.One case of upper thoracic esophageal lesion underwent segmental resection.The median operative time was 53.5(20.0 to 108.0 min).Among 51 cases,26 were treated by endoscopic full-thickness resection,15 by submucosal tunneling endoscopic resection,and 11 by endoscopic submucosal excavation and no serious bleeding occurred during the operation,and there was no case of conversion to surgery.One patient(1.9%)showed a pleural effusion with fever and local atelectasis after surgery,who was improved after thoracic closed drainage.One patient(1.9%)with postoperative bleeding was improved after medical treatment such as ECG monitoring,blood transfusion,anti-infection,acid suppression,hemostasis,and fluid rehydration.One patient(1.9%)with electrocoagulation syndrome was treated by conservative treatment such as fasting,infusion and intravenous antibiotics.The median follow-up time was 36(32.0 to 48.0)months.No metastasis or recurrence was found during follow-up.Conclusion Endoscopic treatment of upper gastrointestinal schwannoma has reliable curative effect,low incidence of complications and good postoperative recovery.It can be used as a safe and effective treatment for upper gastrointestinal schwannoma.