经内镜切除消化道黏膜下肿瘤

目的 探讨内镜切除消化道黏膜下肿瘤(SMT)的疗效、安全性以及切除前内镜超声检查(EUS)的价值。方法 SMT71例中食管36例，胃29例，十二指肠和直肠各3例，64例(90．1％)治疗前行EUS检查。SMT大小6～20mm，平均14．2mm。55例用双活检管道内镜行黏膜切除术(EMR)，把持钳剥离SMT后，将其切除；6例先用圈套器在SMT基底部勒紧，再注入生理盐水，切除SMT；10例≤10mm的用透明帽吸引法切除。结果 71例SMT中68例(95．8％)内镜下完全切除；2例(1例异位胰腺、1例胃平滑肌瘤)病变残留(4周时胃镜发现)；l例直肠平滑肌瘤，未能切除改行外科手术。67例平均随访18．7个月未见复发。组织学诊断平滑肌瘤51例(71．8％)，颗粒细胞瘤、纤维瘤、异位胰腺、脂肪瘤、间质瘤和类癌共15例(21．1％)，5例(7．0％)间叶肿瘤未做免疫染色，不能确定组织来源。并发症：9例局部少量出血，1例胃间质瘤切除后胃穿孔。结论 内镜切除SMT是一种较安全、有效的方法，并可获得组织学诊断，EUS对内镜治疔SMT选择适应证有重要的价值。

Endoscopic resection of gastrointestinal submucosal tumors

Objective To study on the endoscopic resection of submucosal tumors (SMT) in gastro-intestinal tract with especial regards to the effectiveness and safety, and the value of endoscopic ultrasonogra phy ( EUS) in SMT before endoscopic resection. Methods Endoscopic therapy was performed in 71 patients with gastrointestinal SMT diagnosed by endoscopy, and of them 64 patients (90. 1 % ) were examined by EUS before the procedure. The SMT located in the esophagus 36 cases, stomach 29 cases, duodenum 3 cases and rectum 3 cases. The median tumor diameter was 14. 2 mm ( ranged 6-20 mm). Endoscopic mucosal resection was performed using a two-channel endoscope after submucosal injection of saline solution in 55 cases, then the SMT resected. In 16 patients, the SMT was resected completely with one-step standard procedure using cap-fitted endoscope ( 10 cases, the SMT less than 10 mm in diameter) or two-channel endoscope (6 cases). Results Sixty-eight of seventy-one solid SMT were removed completely under endoscopy and 2 SMT (one ectopic pancreas and one gastric leiomyoma) were resected incompletely; the findings were showed at 4th week by repeated endoscopy. One patient with rectal leiomyoma required surgical resection after unsuccessful endoscopic resection. The follow up period was 18. 7 months on average, no recurrences were found in 67 cases. Histological results showed 51 (71. 8% ) leiomyomas, one granular cell tumor, 4 fibromas, 3 ectopic pancreas, 3 lipomas, 2 stromal tumors and 2 carcinoids in the SMT. Five tumors of mesenchymal tissue , their histological origin cannot be firmly defined due to lack of immunoassayed specimen. Bleeding occurred in only 9 of 71 cases and was easily managed with endoscopic haemostatic measures. One patient with stromal tumor suffered from gastric perforation after the procedure. Conclusions Endoscopic resection of gastrointestinal SMT is a safe and effective procedure and obtains the histological diagnosis simultaneously. EUS is helpful in selecting indicated cases for endoscopic resection.