内镜下圈套结扎在治疗上消化道小平滑肌瘤中的应用

目的 探讨应用内镜下皮圈结扎的方法来治疗上消化道的小平滑肌瘤，并评价这种方法的安全性和疗效。方法 通过内镜、内镜超声及内镜超声下穿刺细胞学检查确定了59例上消化道小平滑肌瘤患者，共发现64处平滑肌瘤。在这64处平滑肌瘤中，50处为食管平滑肌瘤，12处为胃平滑肌瘤，2处为十二指肠平滑肌瘤。对所有平滑肌瘤进行皮圈套扎治疗，术后2周开始，每周做胃镜检查观察结扎处的变化，直至创面完全愈合。结果 64处病变中50处食管平滑肌瘤被完全去除，创面的平均愈合时间为3．1周。12处胃平滑肌瘤中9处被完全去除，其余3例由于结扎不彻底，仍有残余瘤组织，平均愈合时间为4.5周。2例十二指病变被完全去除，平均愈合时间4．5周。全部患者无一例发生出血、穿孔。结论 内镜下圈套结扎术是治疗上消化道小平滑肌瘤安全、有效的方法。

Endoscopic band ligation without cauterization: a good technique for excision of upper gastrointestinal small leiomyomas

Objective To evaluate the method of endoscopic band ligation in resecting upper gastrointestinal leiomyoma . Methods We selected 59 patients with 64 small upper gastrointestinal tract leiomyo-mas by endoscopy , EUS and EUS guided fine needle aspiration. Of the 64 leiomyomas, their distribution were in esophagus 50, stomach 12 and duodenum 2. When the endoscope with transparent cap was introduced to reach the lesion, it was sucked into the cap, then released the band to ligate it. Two weeks after operation, endoscopic monitoring of the lesion was performed weekly until the complete healing of the wound. Results In the 64 lesions, 50 esophageal and 2 duodenal leiomyomas were thoroughly resected and the mean concrescence time is 3. 1 weeks and 4. 5 weeks respectively. Nine of 12 gastric leiomyomas were resected thoroughly and the other 3 were partially ligated and resulted in incomplete excision with the mean concrescence time of 4. 5weeks. No perforation occurred. Conclusions Endoscopic band ligation is an ideal method in resecting the small upper gastrointestinal leiomyomas.