经内镜下治疗食管隆起性病变临床分析

发布时间：2018-08-13 12:23

【摘要】：目的：探讨内镜下不同方法治疗食管隆起性病变（esophageal protruded lesions，EPL）的临床疗效及并发症。方法：选取2011年9月至2012年12月经胃镜、超声胃镜、CT诊断为食管隆起性病变并采用内镜下黏膜切除术（EMR）、内镜黏膜下剥除术（ESD）、及黏膜下隧道内镜切除术(STER)切除病灶患者共66例，其中男性38例，女性28例，年龄33-72岁。对患者临床资料、术后跟踪随访情况进行研究分析。结果：1、胃镜下发现病灶共68处，完整切除66处，2处手术中发现为腔外病变，停止内镜操作。66处病灶位于食管上段21处（31.82%），中段23（34.85%）处，下段22处（33.33%），均行内镜下顺利完整切除，未出现穿孔、大出血、气胸、食管狭窄等严重并发症；其中EMR切除37处，ESD切除14处，STER切除15处；术后组织病理学判定完全切除，EMR组切除病灶最大径平均为6.11±3.47mm，ESD组切除标本最大径平均值为14.07±9.56mm，，STER组切除标本最大径平均值为15.31±6.28mm。ESD治疗组切除标本最大径大于EMR组，差异有统计学意义（P0.001）；STER组切除标本最大径大于EMR组，差异有统计学意义（P0.001）。三组切除病灶的分布部位差异有统计学意义（P=0.001）。 2、组织病理学结果显示良性病变60例，其中平滑肌瘤46例，间质瘤2例，囊肿3例，息肉样增生2例，非息肉样增生4例，颗粒细胞瘤1例；非典型增生6例，其中低级别上皮内瘤变2例，高级别上皮内瘤变4例。非典型增生者随访时间为8±6.5月，均未见复发。 3、术后共有35例患者进行1个月的随访，其中EMR组随访15例，ESD组随访10例，STER组随访10例。EMR治疗组中5例（33.33%）患者原病灶切除处出现食管黏膜增生，2例（13.33%）患者食管黏膜出现疤痕；ESD治疗组中3例（30%）患者原病灶切除处出现食管黏膜增生，7例（70%）患者食管黏膜出现瘢痕；STER治疗组中9例（90%）患者术后出现食管黏膜增生，1例（10%）患者食管黏膜出现疤痕；所有术后出现疤痕患者均未引起食管狭窄。ESD与STER两组术后食管黏膜改变存在统计学差异（P=0.02），ESD术后原病灶处食管黏膜易形成瘢痕，而STER术后食管黏膜增生明显。结论：食管隆起性病变可见于食管任何部位，EMR、ESD以及STER是目前治疗该类病变安全有效的方法，但ESD、STER术后易形成疤痕和黏膜增生。
[Abstract]:Objective: to investigate the clinical effect and complications of endoscopic treatment of esophageal protuberance lesions (esophageal protruded lesionsEPL). Methods: from September 2011 to December 2012, 66 patients with esophageal protuberance were diagnosed by endoscopic gastroscopy (CT) and treated with endoscopic mucosal excision (EMR), endoscopic submucosal excision (ESD),) and submucosal tunnel endoscopy (STER). There were 38 males and 28 females aged 33-72 years. The clinical data and follow-up data were analyzed. Results in 1, 68 lesions were found under gastroscopy. Extra-luminal lesions were found in 66 cases of complete excision, 21 (31.82%) were located in upper esophageal segment, 23 (34.85%) in middle segment, and 22 (33.33%) in lower segment. All the lesions were resected smoothly and completely under endoscope, and all of the lesions were located in 21 (31.82%) of the upper esophagus, 23 (34.85%) of the middle segment, and 22 (33.33%) of the lower segment. There were no severe complications, such as perforation, hemorrhage, pneumothorax, esophageal stenosis, etc. The mean maximum diameter of excision specimen in EMR group was 14.07 卤9.56mmSter group was 15.31 卤6.28mm.ESD group, which was higher than that in EMR group (P0. 001), and the mean maximum diameter of excision specimen in EMR group was 6.11 卤3.47 mm ~ (-1), which was higher than that in EMR group (P < 0. 001). The maximum diameter of excision specimen in STER group was larger than that in EMR group (P 0.001). There were significant differences in the distribution of lesions among the three groups (P0. 001). The histopathological results showed that there were 60 cases of benign lesions, including 46 cases of leiomyoma, 2 cases of stromal tumor, 3 cases of cysts, 2 cases of polypoid hyperplasia. There were 4 cases of nonpolypoid hyperplasia, 1 case of granulosa cell tumor, 6 cases of atypical hyperplasia, 2 cases of low grade intraepithelial neoplasia and 4 cases of high grade intraepithelial neoplasia. The follow-up time of atypical hyperplasia was 8 卤6.5 months, and no recurrence was found. A total of 35 patients were followed up for 1 month. Among them, 15 cases in EMR group were followed up in EMR group, 10 cases in ster group. 5 cases (33.33%) in EMR treatment group had esophageal mucosal hyperplasia at the original lesion resection site, 2 cases (13.33%) had esophageal mucosal scar. In the ESD treatment group, 3 cases (30%) had esophageal mucosal hyperplasia at the resection site, 7 cases (70%) had esophageal mucosal hyperplasia, 9 cases (90%) had esophageal mucosal hyperplasia and 1 case (10%) had esophageal mucosal scar in the esophageal mucosal scar group. There was no significant difference between the two groups in esophageal mucosal changes after operation (P0. 02). However, esophageal mucosal hyperplasia was obvious after STER. Conclusion: EMR-ESD and STER are safe and effective methods for the treatment of esophageal protruding lesions, but scar and mucosal hyperplasia are easy to be formed after ESD / STER.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R571

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