内镜切除治疗食管神经鞘瘤的效果

Clinical effect of endoscopic resection for esophageal schwannoma

摘要:

目的 探讨食管神经鞘瘤的临床病理特点，以及内镜黏膜下剥离术（ESD）和内镜经黏膜下隧道肿瘤切除术（STER）切除食管神经鞘瘤的效果。方法 回顾性分析2007年8月－2019年7月南京大学医学院附属鼓楼医院消化科收治的11例食管神经鞘瘤患者的临床特征、内镜下表现、术后并发症和病理特点。结果 男患者占54.5%；年龄40～81岁，平均（57.5±12.4）岁；食管神经鞘瘤多位于胸上段（45.5%，5/11）和胸中段（27.3%，3/11）；11例（100.0%）病灶的白光内镜分型均为隆起型，表面黏膜光滑、无溃疡。肿瘤直径为0.3～5.0 cm，平均（2.5±1.8）cm；超声内镜（EUS）显示10例（90.9%）起源于固有肌层，11例均为低回声，9例（81.8%）回声均匀；11例EUS下均无血流信号，6例（54.5%）为腔内生长，5例（45.5%）腔内外生长。完整切除率为100.0%（11/11），中位手术时间41 min，11例患者（100.0%）均未出现穿孔、迟发性出血和感染等并发症；术后首次进流食时间为（1.2±0.6）d；平均住院时间为（6.9±2.5）d。所有组织标本中S100均为阳性；中位随访时间为53个月，期间未发生局部复发、远处转移和死亡。结论 ESD和STER用于诊断和治疗食管神经鞘瘤是安全、有效的。

Abstract:

Objective To evaluate the clinicopathological features of esophageal schwannoma, and the effect of endoscopic submucosal dissection (ESD) and submucosal tunneling endoscopic resection (STER) for esophageal schwannoma.Methods The clinical characteristics, endoscopic characteristics, postoperative complications and pathological characteristics of 11 patients with esophageal schwannoma from August 2007 to July 2019 were retrospectively analyzed.Results Men accounted for 54.5%; The average age was (57.5 ± 12.4) years (40 ~ 81 years). Esophageal schwannomas are mostly located in the upper thoracic segment (45.5%, 5/11) and the middle thoracic segment (27.3%, 3/11). The white light endoscopic classification of 11 cases (100.0%) were all eminence type. The mucous membranes were smooth without ulcer. The mean tumor diameter was (2.5 ± 1.8) cm (0.3 ~ 5.0 cm). Meanwhile, endoscopic ultrasonography (EUS) showed that 10 cases (90.9%) had originated in the muscularis propria. All the 11 patients were hypoechoic, including 9 patients (81.8%) with homogeneous echo. There was no blood flow signal under endoscopic ultrasonography in 11 patients. In terms of growth mode, 6 cases (54.5%) were intraluminal growth and 5 cases (45.5%) were intraluminal and extraluminal growth. The complete resection rate was 100.0% (11/11). The median operation time was 41 min. None of the 11 patients (100.0%) had the complications such as perforation, delayed hemorrhage and infection. The time of initial postoperative fluid intake was (1.2 ± 0.6) d; The mean length of hospital stay was (6.9 ± 2.5) d. All tissue specimens were positive for S100. No local recurrence, distant metastasis and death occurred during the period.Conclusion ESD and STER are safe and effective in the diagnosis and treatment of esophageal schwannoma.