内镜黏膜下剥离术切除食管血管瘤二例并文献复习

Endoscopic submucosal dissection for esophageal hemangioma: report of two cases and review of the literature

目的探讨食管血管瘤的临床病理特征、诊断及治疗,提高临床医师对本病的认识。方法报道我院2例经内镜黏膜下剥离术切除食管血管瘤病例并进行相关文献复习。以'食管血管瘤'和'内镜黏膜下剥离术'为关键词在中国知网数据库、万方数据库进行检索,以'esophageal hemangioma'和'endoscopic submucosal dissection'为关键词在Pub Med、Elsevier、Springer、Wiley、OVID、EBSCO数据库进行检索,检索时间截止2016年3月31日。结果检索到中文文献6篇,但均无食管血管瘤患者的详细资料。检索到英文文献4篇,剔除重复报道。共检索到3例内镜黏膜下剥离术切除食管血管瘤病例,与我院报道的2例病例进行汇总分析。5例中,男2例,女3例,年龄29~64岁。2例无症状,3例表现为吞咽困难。5例食管血管瘤超声内镜下均起源于黏膜下层,4例为边界清晰的低回声,1例为边界不清的高回声。4例行胸部CT检查,2例病变为软组织密度影,1例病变为高密度组织影,1例病变为强化组织影。术前仅1例行胃镜下活检病理检查,但提示炎性渗出及坏死组织,未能确诊。术后病理4例为海绵状血管瘤,1例为毛细血管瘤。术后随访2例6个月无复发,1例8个月无复发,1例6周无复发,1例无随访资料。结论食管血管瘤临床罕见,胃镜、超声胃镜、胸部CT检查有助于鉴别诊断,病理组织学检查是其诊断金标准。内镜黏膜下剥离术切除食管血管瘤安全、有效,值得进一步深入研究。

Objective To explore the clinicopathological characteristics, diagnosis and treatment of esophageal hemangioma so as to improve clinical physician awareness of the disease. Methods Two cases of esophageal hemangioma treated by endoscopic submucosal dissection in our hospital were reported and the related literatures were reviewed. 'Esophageal hemangioma' and 'endoscopic submucosal dissection' as the Chinese keywords to retrieve the literature from CNKI database and Wanfang database, 'esophageal hemangioma' and 'endoscopic submucosal dissection' as the English keywords to retrieve the literature from Pub Med, Elsevier, Springer, Wiley, OVID and EBSCO database, by the end of March 2016. Results A total of six articles were retrieved in Chinese literature, but there were no clinical details of the patients with esophageal hemangioma. Four articles were retrieved in English literature, eliminate duplicate reports. A total of three cases of esophageal hemangioma treated by endoscopic submucosal dissection were retrieved, clinicopathological data were collected and analyzed with two cases reported by our hospital. Among the five cases, two were male and three were female, aged 29-64 years old. Two cases of asymptomatic, three cases had dysphagia. All the five cases of esophageal hemangioma were originated from the submucosal layer, four cases were hypoechoic with clear boundary, one case was hyperechoic with unclear boundary. Four cases underwent chest CT, two cases of soft tissue mass, one case of hyperdense mass and one case of enhanced mass. Only one case performed endoscopic biopsy before endoscopic submucosal dissection, the inflammatory exudate and necrotic tissue were suggested. Postoperative pathology in four cases were cavernous hemangioma, one case was capillary hemangioma. No recurrence was followed up in two cases for six months, one case for eight months, one case for six weeks and one case had no follow-up data. Conclusions Esophageal hemangioma are rare, endoscopy, endoscopic ultrasound, chest CT is helpful in the differential diagnosis, histopathological examination is the gold standard for the diagnosis. Endoscopic submucosal dissection is a safe and effective treatment for esophageal hemangioma and deserves further study.