临床肿瘤学杂志
臨床腫瘤學雜誌
림상종류학잡지
CHINESE CLINICAL ONCOLOGY
2014年
6期
503-507
,共5页
黏膜下肿瘤%内镜下黏膜切除术%内镜下黏膜剥离术%内镜下黏膜挖除术%内镜下消化道壁全层切除术
黏膜下腫瘤%內鏡下黏膜切除術%內鏡下黏膜剝離術%內鏡下黏膜挖除術%內鏡下消化道壁全層切除術
점막하종류%내경하점막절제술%내경하점막박리술%내경하점막알제술%내경하소화도벽전층절제술
Submucosal tumor%Endoscopic mucosal resection( EMR)%Endoscopic submucosal dissection( ESD)%En-doscopic submucosal excavation( ESE)%Endoscopic full-thickness resection( EFR)
目的:观察经内镜治疗食管、胃和十二指肠的黏膜下肿瘤( SMT)的疗效和安全性以及术后病理组织学诊断情况。方法共入组426例上消化道SMT患者,其中位于食管346例,胃79例,十二指肠1例。经超声内镜诊断SMT位于黏膜肌层284例,黏膜下层87例,固有肌层55例。病变最大直径为0?4~6cm,平均(0?90±0?03)cm。426例SMT中333例行黏膜切除术( EMR),37例行黏膜剥离术( ESD),47例行黏膜挖除术( ESE),9例行全层切除术( EFR)。结果 EMR组中314例完整切除病变,完整切除率为94?3%。 ESD组、EFR组均完整切除病灶,完整切除率100?0%。 ESE组44例病灶完整切除,完整切除率93?6%(44/47),3例治疗失败转行外科手术。 ESD组穿孔和出血各1例,发生率为2?7%;ESE组穿孔2例,出血2例,发生率为4?25%。 EFR组为实现病灶完整切除,均将瘤体以及与之相连的固有肌层一并切除,实施主动穿孔,术后完全缝合胃壁缺损。术后病理组织学结果显示平滑肌瘤326例,间质瘤58例,异位胰腺、脂肪瘤、潴留囊肿、颗粒细胞瘤、血管机化、淋巴管瘤、血管瘤和神经鞘瘤共42例。患者术后均随访2年,无一例复发。结论经内镜治疗上消化道SMT安全、有效。
目的:觀察經內鏡治療食管、胃和十二指腸的黏膜下腫瘤( SMT)的療效和安全性以及術後病理組織學診斷情況。方法共入組426例上消化道SMT患者,其中位于食管346例,胃79例,十二指腸1例。經超聲內鏡診斷SMT位于黏膜肌層284例,黏膜下層87例,固有肌層55例。病變最大直徑為0?4~6cm,平均(0?90±0?03)cm。426例SMT中333例行黏膜切除術( EMR),37例行黏膜剝離術( ESD),47例行黏膜挖除術( ESE),9例行全層切除術( EFR)。結果 EMR組中314例完整切除病變,完整切除率為94?3%。 ESD組、EFR組均完整切除病竈,完整切除率100?0%。 ESE組44例病竈完整切除,完整切除率93?6%(44/47),3例治療失敗轉行外科手術。 ESD組穿孔和齣血各1例,髮生率為2?7%;ESE組穿孔2例,齣血2例,髮生率為4?25%。 EFR組為實現病竈完整切除,均將瘤體以及與之相連的固有肌層一併切除,實施主動穿孔,術後完全縫閤胃壁缺損。術後病理組織學結果顯示平滑肌瘤326例,間質瘤58例,異位胰腺、脂肪瘤、潴留囊腫、顆粒細胞瘤、血管機化、淋巴管瘤、血管瘤和神經鞘瘤共42例。患者術後均隨訪2年,無一例複髮。結論經內鏡治療上消化道SMT安全、有效。
목적:관찰경내경치료식관、위화십이지장적점막하종류( SMT)적료효화안전성이급술후병리조직학진단정황。방법공입조426례상소화도SMT환자,기중위우식관346례,위79례,십이지장1례。경초성내경진단SMT위우점막기층284례,점막하층87례,고유기층55례。병변최대직경위0?4~6cm,평균(0?90±0?03)cm。426례SMT중333례행점막절제술( EMR),37례행점막박리술( ESD),47례행점막알제술( ESE),9례행전층절제술( EFR)。결과 EMR조중314례완정절제병변,완정절제솔위94?3%。 ESD조、EFR조균완정절제병조,완정절제솔100?0%。 ESE조44례병조완정절제,완정절제솔93?6%(44/47),3례치료실패전행외과수술。 ESD조천공화출혈각1례,발생솔위2?7%;ESE조천공2례,출혈2례,발생솔위4?25%。 EFR조위실현병조완정절제,균장류체이급여지상련적고유기층일병절제,실시주동천공,술후완전봉합위벽결손。술후병리조직학결과현시평활기류326례,간질류58례,이위이선、지방류、저류낭종、과립세포류、혈관궤화、림파관류、혈관류화신경초류공42례。환자술후균수방2년,무일례복발。결론경내경치료상소화도SMT안전、유효。
Objective To evaluate the efficacy and safety of endoscopic resection for submucosal tumors( SMT) of upper gas-trointestinal tract and to analyze histological type of SMT. Methods Of 426 SMTs, 346 located in esophagus, 79 in stomach, 1 in du-odenum. By endoscopic ultrasonography(EUS), 284 lesions were in muscularis mucosa, 87 in submucosal layer, 55 in muscularis propia. Lesions ranged from 0?4cm to 6cm(0?90±0?03cm). Three hundred and thirty-three patients were managed by endoscopic mu-cosal resection(EMR), 37 by endoscopic submucosal dissection(ESD), 47 by endoscopic submucosal excavation(ESE), and 9 by endoscopic full-thickness resection( EFR) . Results In EMR group, 314 out of 333 lesions( 94?3%) were en bloc resected, compared with 100?0% in ESD group and EFR group,and 44 out of 47 lesions( 93?6%) in ESE group. Three cases( 2 complicated with unman-aged perforation,1 with maximum diameter reaching 6cm) from ESE group performed surgery for unsuccessful endoscopic resection. 1 case from ESD and ESE group each with delayed hemorrhage had endoscopic hemostatic therapy without surgery. Nine active perforation in EFR group were all successfully managed by endoscopy. Three hundred and twenty-six lesions were histopathologically diagnosed as leiomyoma, 58 as gastrointestinal stromal tumors. No case relapsed in 2 years followed-up. Conclusion Endoscopic resection can be a safe and effective treatment for upper gastrointestinal tract SMT.