上消化道固有肌层肿瘤的内镜治疗

目的探讨三种常见的内镜治疗方法对于起源于固有肌层的上消化道肿瘤的治疗价值。方法通过胃镜及超声内镜筛选出2011至2013年共70例患有上消化道固有肌层肿瘤的病例,根据肿瘤的位置及深度采用三种常见的内镜治疗方法给予切除。三种方法是:内镜黏膜下挖除术(ESE),内镜全层切除术(EFR),内镜经黏膜下隧道肿瘤切除术(STER)。切除肿瘤术后均经免疫组化及分子生物学等相关病理检测,检测指标为CD34、CD117、Dog-1、S-100、平滑肌肌动蛋白(SMA)、Ki-67以及核分裂数。结果共有35例患者接受ESE治疗,其中2例出现穿孔,通过钛夹修补;27例接受STER治疗,未出现穿孔并发症;8例接受EFR治疗,均有"人工"穿孔,通过钛夹完全修补。所有70例经过治疗后均完全康复,未追加外科手术治疗。结论上消化道固有肌层肿瘤可通过内镜治疗成功切除,可逐步替代外科手术治疗,且有更大的应用范围。

Endoscopic therapy for muscularis propria tumor of upper gastrointestinal tract

Objective To explore the therapeutic value of three common endoscopic therapy methods for upper gastrointestinal tumors originating from the muscularis propria. Methods For 70 cases diagnosed as muscularis propria tumor of upper gastrointestinal tract revealed in the examinations of gastroendoscope and ultrasound gastroendoscope from 2011 to 2013,three types of endoscopic therapy methods were selected,based on the location and depth of the tumor. These methods included endoscopic submucosal excavation（ ESE）,endoscopic full-thickness resection（ EFR） and submucosal tunneling endoscopic resection（ STER）. Immunohistochemistry and molecular biology for CD34,CD117,Dog-1,S-100,smooth muscle actin（ SMA）,Ki-67 and mitotic count were performed on the resected tumors. Results A total of 35 cases were treated with ESE,2 cases were complicated by perforation,and the perforations were closed with metal clips. Additionally,27 cases were treated with STER,and no perforation occurred. Finally,8cases were treated with EFR,all of the cases were complicated by artificial perforation,and all of the perforations were closed with metal clips. All of the 70 cases recovered with medical treatment,and none required surgical operation. Immunohistochemistry and molecular biology demonstrated that among all of the70 cases,29 cases were gastric stromal tumors,and the other 41 cases were gastric leiomyomas.Conclusions Muscularis propria tumor of upper gastrointestinal tract can be treated successfully with endoscopic techniques,which could replace certain surgical operations and should be considered for further application.