内镜黏膜下挖除术治疗食管固有肌层肿瘤.pdfVIP

内镜黏膜下挖除术治疗食管固有肌层肿瘤 钟芸诗 时强 姚礼庆 周平红 徐美东 陈巍峰 李全林 蔡贤黎 王萍 [摘要] 目的 探讨内镜黏膜下挖除术(ESE)治疗食管固有肌层肿瘤的临床价值。方法 回 顾性分析2008年12月至2010年12月27例行ESE治疗的食管固有肌层肿瘤患者的资料，评价治 疗的可行性、安全性和疗效。结果 27例患者共29个病灶，病变直径0.5 ～3.0 cm，平均(1.25± 0.70 )cm。切除率96. 3％ (26/27)，1例患者中转手术治疗。中位手术时间74（30 ～120）min。术 后病理诊断平滑肌瘤26例，间质瘤1例。2例术中穿孔伴气胸，金属夹夹闭创面后予胸腔闭式引 流，未行开胸手术修补。中位随访时间12(3 ～27)个月，未见复发病例。结论 对于直径小于 3.0 cm、腔内生长为主的食管固有肌层肿瘤，ESE治疗具有安全、有效的特点，并可提供完整的病理 学诊断资料，进一步扩大了内镜治疗的范围。 食管；固有肌层； 内镜黏膜下挖除术 Endoscopic submucosal excavation of esophageal submucosal tumors originating from the muscularis propria layer ZHONG Yun-shi SHI Qiang YAO Li-qing ZHOU Ping-hongXU Mei-dong CHEN Wei- fengLI Quan-linCAI Xian-li, WANG Ping Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China [ Abstract] Objective To study the value of endoscopic submucosal excavation (ESE) for esopha geal submucosal tumors originating from the muscularis propria layer. Methods Data of 27 patients with 29 lesions in esophageal muscularis propria treated with ESE from Dec. 2008 to Dec. 2010 were retrospected. Feasibility, effects and safety were evaluated accordingly. Results Of 27 patients,there were 17 males and 10 females. Mean age was 50(22 ～62)yrs,and mean diameter of the lesions was 1.25 ±0. 70 (0. 5 ～3.0) cm. Resection rate was 96. 3％ (26/27). One failed case with tumor residual after ESE received additional operation. The median procedure time was 74 (30-120) min. Pathological examination confirmed leiomyoma in 26 cases and gastrointestinal stromal tumor (GISTs) in 1 case. Perforation during operation occurred in 2 cases, accompanied with pneumothorax. They were treated with closed thoracic drainage, without surgery. The median follow-up time was 12 months (3 to 27 months), and no recurrence was found. Conclusion ESE is a safe and effective therapy for the esophageal tumor smaller than 3.0 cm from the muscularis prop Esophagus; Muscularis propria; Endoscopic submucosal