内镜治疗消化道粘膜下肿瘤

目的探讨内镜治疗消化道粘膜下肿瘤(SMT)的疗效、安全性和组织学诊断。方法内镜诊断消化道SMT82例,70例(85.4%)治疗前行超声内镜(EUS)检查。SMT位于食管45例。胃29例,十二指肠和直乙状结肠各4例。除5例囊肿外,SMT大小6～20mm。53例用双活检管道内镜行粘膜切除术(EMR),把持钳剥离SMT后,将其切除,14例(SMT≤10mm)一次性用吸引法切除(10例)或用双管道内镜直接切除(4例);10例食管孤立性静脉瘤内镜套扎,5例囊肿切开引流或抽吸囊液。结果 67例实体SMT中64例(98.5%)内镜下完全切除,2例(异位胰腺和胃平滑肌瘤各1例)病变部分残留,4周时复查胃镜发现;1例直肠平滑肌瘤,未能切除。10例静脉瘤和5例囊肿均治疗有效。平均随访13.4个月未见复发。组织学诊断平滑肌瘤49例(59.8%),颗粒细胞瘤,纤维瘤、异位胰腺、脂肪瘤和类癌共13例(15.9%),5例间叶肿瘤未做特殊染色,不能确定组织来源。82例内镜治疗11例局部少量出血,无穿孔等严重并发症。结论内镜治疗SMT是一种安全、有效的方法,并可获得组织学诊断,EUS对内镜治疗SMT选择适应证有重要的价值。

Endoscopic management of gastrointestinal submucosal tumors

Objective To evaluate the efficacy and safety of endoscopic therapy for xubmucosal tumors(SMT) of the gastrointestinal tract, and histologic diagnosis.Methods Endoscopic therapy was performed in dighty-two patients with gastrointestinal simple SMT diagnosed by en- doseopy,and 70 patients (85.4%) of them were examined by endoscopic ultrasonography (EUS) befre the treatment.There were 45 patients with SMT located in the esophagus,29 in the stomach,and 4 in the duodenum and rectal-sigmoid colon repectively.Median tumoe diameter was 13.9mm (eange6-20mm) except for 5 cases of cysts.Endoxcopic mucosal resection was performed using a two-chnnel endoxcope after submucosal saline solution injection in 53 cases,afterwards SMT was removed.In 14 patients with SMT less than or equal 10mm in diameter,the SMT was resected completely with one-step method of standaed proceture using cap-fitted endoscope (10) or two-channel endoscope (4) .Ten solitaey varices and 5 cysts were.treated by band ligation of the varices and using cutting of xuction technique for the cysts repective- ly.Results Sixty-four of sixty-seven solid SMT were removed completely by endoscopy,and 2 SMT (one ectopic pancreas and one gastric leiomyoma) wer resected incompletely,the findings were showed by repeated endoscopy at 4th week.One patient with rectal leiomyoma required surgical resection after unsuccessful endoscopic resection.Ten patients with solitary varices and 5 patients with cyst were treated effectively.The fol- low up of period with an average of 13.4 months no recurrent was found in 79 cases.Histological results showed 49 leromyomas,one granular cell tumor,4 fibromas,3 lipomas,3 ectopic pancreas and 2 caecinoids in the solid submueusal tumors.Five tumors of mesenchymal tissue about his- tologcal origin can be not distinguished because of no using specific immunostaining.Bleeding occurred in only 11 of 82 cases and was easily man- aged with endoscopic hemostatic methods.There was no perforation in all the patients.Conclusion Endoscopic resection of gastrointestinal SMT can be a safe and dffective method and obtaining histological diagnosis of the SMT.EUS is useful for endoscopic management of SMT about select- ing the indications.