内镜超声在食管黏膜下肿物临床诊疗中的应用价值

Endoscopic ultrasonography in clinical diagnosis and treatment of esophageal submucosal tumors

摘要:

探讨内镜超声在食管黏膜下肿物（SMT）临床诊疗中的应用价值。方法?回顾性分析该院113例胃镜下发现的食管SMT并行超声内镜（EUS）检查的患者，收集患者115处SMT病变的临床特点、内镜检查治疗和病理组织学结果等资料，并对术后患者进行随访。结果?SMT好发于食管上段44处（38.26%）和中段（38/115，33.04%）；病理结果显示，84.35%为平滑肌瘤（97/115），另外5处食管囊肿（4.35%），5处黏膜下固有腺体增生伴导管扩张（4.35%），2处间质瘤（1.74%），2处脂肪瘤（1.74%），1处神经鞘瘤（0.87%），1处血管瘤（0.87%），1处浆液性腺瘤（0.87%），1处颗粒细胞瘤（0.87%）；EUS诊断符合率分别为平滑肌瘤93.00%（93/100），食管囊肿55.50%（5/9），间质瘤0.00%（0/3），脂肪瘤100.00%（2/2），血管瘤100.00%（1/1）。EUS诊断起源于黏膜肌层者，主要选择内镜下黏膜切除术（EMR）（76.12%，51/67）和内镜黏膜下剥离术（ESD）（23.88%，16/67）治疗，起源于黏膜下层者，主要选择EMR（35.71%，5/14）和ESD（64.29%，9/14）治疗，起源于固有肌层或累及固有肌层者，多选择经内镜黏膜下隧道肿瘤切除术（STER）（84.85%，28/33）治疗。免疫组化结果示平滑肌瘤98.97%（96/97）平滑肌肌动蛋白（SMA）和97.94%（95/97）结蛋白（Desmin）表达阳性。结论?EUS对SMT的病理性质可进行较准确的诊断，并指导食管SMT内镜下微创手术方式的选择，能进行安全有效的治疗，但对食管间质瘤、神经鞘瘤等少见食管肿瘤的诊断具有一定的局限性。

Abstract:

To explore the clinical value of endoscopic ultrasonography in diagnosis and treatment of esophageal submucosal tumors (SMT). Methods 93 patients with esophageal SMT (196 lesions totally) were diagnosed under endoscopic ultrasonography (EUS) and treated with endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), were retrospectively analyzed. Clinical data such as clinical features, endoscopic appearance and treatment, histopathological findings and follow-up information of postoperative patients were collected. Results Most of the esophageal SMTs were located in the upper (44/115 38.26%) and middle (38/115 33.04%) esophagus. Histological diagnosis showed that most esophageal SMTs were predominately leiomyomas (84.35%, 97/115), and 5 esophageal cysts (4.35%), 5 submucosal hyperplasia with ductal dilatation (4.35%), 2 stromal tumors (1.74%), 2 lipomas (1.74%), 1 neurilemmoma (0.87%), 1 hemangioma (0.87%), 1 serous adenoma (0.87%), 1 granular cell tumor (0.87%). The overall coincidence rate of EUS diagnosis is 87.83% (101/115), for leiomyoma 93.00% (93/100), esophageal cyst 55.50% (5/9), stromal tumor 0.00% (0/3), lipoma 100.00% (2/2), hemangioma 100.00% (1/1). Endoscopic resection with EMR and ESD were performed. SMTs from the mucosal muscle layer were 76.12% (51/67) with EMR and 23.88% (16/67) with ESD respectively. SMTs from the submucosa were 35.71% (5/14) with EMR and 64.29% (9/14) with ESD, SMTs originated from the muscular layer were mainly 84.85% (28/33) resected with submucosal tunneling endoscopic resection (STER). Resected tissues were further examined with immunohistochemistry and results for leiomyomas neurogenic markers revealed that 98.97% (96/97) were positive for SMA, 97.94% (95/97) for Desmin. Conclusion Endoscopic ultrasonography can accurately diagnose the pathological properties of esophageal SMTs, and provide useful information in selecting endoscopic resection methods. However, the diagnostic value for rare esophageal tumors such as stromal tumors and schwannomas is still limited.