ESD及STER在食管平滑肌瘤治疗中的应用

目的研究内镜黏膜下剥离术（ESD）及内镜黏膜下隧道肿瘤切除术（STER）在食管平滑肌瘤治疗中的应用价值。方法回顾性分析22例经ESD或STER治疗、术后病理及免疫组化确诊为食管平滑肌瘤的患者的基本情况、病变部位、临床表现、治疗情况、组织学特征以及术后随访结果。结果14例经ESD治疗，8例经STER治疗。超声内镜示病变位于黏膜肌层9例，固有肌层13例。CT检查阳性率27．27％。所有病变均一次性完整切除。手术切除肿瘤大小为0．2～3．0cm，平均（1．35±0．78）cm。STER组的手术时间（51．50±7．61）min，比ESD组的（81．64±6．57）min短，差异有统计学意义（P=0．009）；术中出血量STER组（50．00±8．66）mL，比ESD组的（81．42±7．10）mL少，差异有统计学意义（P=0．013）。SMA及Desmin检测阳性率均为100．00％，CD117灶阳性率为68．18％，CD34血管阳性率为45．45％，DOG-1阳性率为9．09％，Ki-67为〈5％阳性。除1例患者STER术后出现食管脓肿，余2l例患者均未出现并发症，所有患者2个月后复查恢复良好，无复发。结论STER和ESD均可用于食管平滑肌瘤的治疗，相比ESD，STER在手术时间及术中出血量上更有优势，有望成为治疗黏膜下肿瘤（尤其是起源于固有肌层）的主要方法。

Application of ESD and STER in the Treatment of Esophageal Leiomyoma

Objective To evaluate the application value of endoscopic submucosal dissection （ESD） and endo- scopic submucosal tunnel tumor resection （STER） in the treatment of esophageal leiomyoma. Methods The data of 22 patients with esophageal leiomyoma underwent ESD or STER and confirmed by pathology were reviewed in the terms of personal situation,location and size of lesions, clinical manifestation, managements, pathology, complications and follow-up findings. Results Fourteen cases were treated with ESD, 8 cases with STER treatment. Endoscopic ultrasonography showed 9 cases of muscularis mucosa lesions, 13 cases of muscularis propria. The CT-positive rate was 27.27 %. All the lesions were once complete resection. Surgical resection of the tumor size was 0.2-3.0 cm, the average was （ 1.35± 0.78 ） cm. The operating time was significantly shorter （ P = 0. 009 ） for STER [ （ 51.50± 7.61 ） min] than for ESD [ （ 81.64± 6.57 ） rain ], while the blood loss was less （ P = 0.013 ） for STER [ （50.00 ± 8.66） roLl than for ESD [ （81.42±7. 10） mL]. the SMA and Desmin testing positive rate was 100.00%, the CD117 foci-positive was 68.18%, the CD34 blood-vessels positive rate was 45.45%, the DOG-1 positive rate was 9.09% ,the Ki-67 were 〈 5% positive. In addition to the postoperative esophageal abscess in 1 patients with STER,the other 21 patients had no complications. All the patients recovered well without recurrence in two months after the review. Conclusion ESD and STER can be used in the treatment of esophageal leiomyoma. Compared with ESD, STER has more advantages in the operating time and blood loss. It is expected to become the main treatment of submucosal tumors （especially originated in the muscularis propria）.