内镜黏膜下剥离术治疗食道固有肌层肿瘤12例临床研究.docVIP

内镜黏膜下剥离术治疗食道固有肌层肿瘤12例临床研究[摘要] 目的 探讨内镜黏膜下剥离术（ESD）治疗食道固有肌层肿瘤的疗效和安全性。 方法 对胃镜及超声胃镜检查发现的来源于食道固有肌层的肿瘤应用IT刀、HOOK刀、Ⅰ型海博刀进行ESD治疗。 结果 12例来源于食道固有肌层的肿瘤全部完整剥离，肿瘤直径0.5～3.0 cm。组织学诊断为9例平滑肌瘤，2例间质瘤，1例平滑肌肉瘤。没有发生穿孔、大出血等严重并发症。所有12例患者随访1～12个月，无一例复发。免疫组化结果：本组12例CD34为17.4%阳性，CD117为17.4%阳性，Vimentin为73.9%阳性。 结论 ESD是治疗食道固有肌层肿瘤的安全、有效方法，在提供完整的病理学诊断资料同时还可以完整切除病变。 [关键词] 内镜黏膜下剥离术；肿瘤；胃肠道间质瘤 [中图分类号] R735 [文献标识码] B [文章编号] 1673—9701（2012）26—0024—02 Endoscopic submucosal dissection of esophageal submucosal tumors originating from the muscularis propria layer： report of twelve cases JING Yuanming YANG Feiying YE Minfeng TAO Feng Department of Gastrointestinal Surgery， Shaoxing People’s Hospital， Shaoxing 312000， China [Abstract] Objective To study the curative effect and safety of ESD in the treatment of muscularis propria tumor in esophagus. Methods IT knife， HOOK knife and hybrid knife were applied in the ESD treatment of muscularis pmpria tumor in esophagus revealed in the examinations of gastroendoscope and ultrasound gastroendoscope. Results The muscularis propria tumors with a diameter of 0.5—3.0 cm in esophagus of 12 cases were wholly removed. 9 cases of leiomyomas， 2 cases of stromal tumors， and one case of leiomyosarcoma were histologic diagnosed， respectively. No perforation or bleeding was found. All the 12 patients were followed up for 1 to 12 months and there was no relapse. The immunohistochemical results showed that CD34 and CD117 of 12 cases were 17.4% positive， Vimentin 73.9% positive. Conclusion The ESD treatment for muscularis pmpria tumor in esophagus is reliable curative effect， it can not only wholly remove the tumors， but also provide pathological proves for reference. [Key words] Endoscopic submucosal dissection （ESD）； Tumor； Gastrointestinal stromal tumors 内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）是目前最常用的大面积病变切除方法，已成为消化道肿瘤的标准微创治疗手段，并广泛用于上消化道，特别是胃。在日本，ESD已被确立为上消化道恶性肿瘤内镜切除的标准方法[1]。由于食道壁层相对较薄，并缺乏浆膜层保护，技术要求高，操作不慎将出现穿孔等严重并发症，国内开展相对较晚，经验不足。本文回顾了ESD方法的实例和临床应用，探讨食道固有