上消化道黏膜下肿瘤特点及内镜下治疗的效果和安全性分析

目的分析上消化道黏膜下肿瘤的临床特点及内镜下治疗的效果和安全性。方法收集2012-02~2017-02该院收住的上消化道黏膜下肿瘤患者264例,采用内镜下治疗,切除标本行常规病理及免疫组化检查。统计各种黏膜下肿瘤的性质、起源和分布。所有患者术后随访1年。结果 264例患者中,病变部位食管黏膜下肿瘤占65. 9%,胃黏膜下肿瘤占33. 0%,十二指肠黏膜下肿瘤占1. 1%。病变性质平滑肌瘤占72. 3%,间质瘤占12. 1%,脂肪瘤占5. 3%,异位胰腺占4. 6%,神经鞘瘤占1. 5%,囊肿占1. 1%,神经内分泌瘤占1. 1%,静脉瘤占1. 1%,颗粒细胞瘤占0. 8%。所有患者术后1年复查胃镜,未见复发及并发症。结论上消化道黏膜下肿瘤以良性肿瘤为主,其中分布于食管最多见,其次是胃,十二指肠最少。食管黏膜下肿瘤以平滑肌瘤最多见,胃以平滑肌瘤、间质瘤最多见。对于直径≤4 cm的上消化道黏膜下肿瘤,如平滑肌瘤、间质瘤、脂肪瘤、异位胰腺、神经鞘瘤、囊肿、神经内分泌瘤、静脉瘤、颗粒细胞瘤、血管瘤等,均可采取内镜下手术治疗,且安全、有效。

Analysis of the characteristics and endoscopic treatment of upper gastrointestinal submucosal tumors

Objective To analyze the clinical features and safety of submucosal tumors(SMTs)in the upper gastrointestinal tract.Methods Two hundred and sixty-four patients with upper gastrointestinal SMTs were selected as the study subjects in our hospital from February 2012 to February 2017,endoscopic treatment of SMTs in the upper gastrointestinal tract was performed.The specimens were resected for routine pathological examination and immunohistochemical analysis.The sizes,distributions and depth of lesions in all kinds of submucosal masses were investigated.All the patients were followed up for 12 months after surgery.Results Of the 264 patients included,65.9%had submucosal tumors,33.0%had submucosal tumors,and 1.1%had duodenal submucosal tumors.Among all the tumors,72.3%were leiomyomas,12.1%were stromal tumors,5.3%were lipomas,4.6%were ectopic pancreas,1.5%were schwannomas,1.1%were cysts,1.1%were neuroendocrine tumors,1.1%were varicose vein and 0.8%were granulosa cell.No recurrence or complications were found.Conclusion The SMTs of upper gastrointestinal tract are mainly composed of benign masses which are most commonly seen in the esophagus,followed by the stomach and the least duodenum.The SMTs of the esophagus are the most common in leiomyoma,and the stomach is the most common site for leiomyoma and stromal tumors.The tumors with diameter is less than or equal to 4 cm,such as leiomyoma,stromal tumor,lipoma and ectopic pancreas,schwannoma,cyst,neuroendocrine tumor,varicosity,granular cell tumor,hemangioma,can be treated with endoscopic surgery,and the treatment is safe and effective.