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内镜在胃肠道神经鞘瘤中的诊治价值探讨

(2014-10-22 12:23:54)

    【摘要】

    目的  探讨胃肠道神经鞘瘤的内镜诊断及内镜治疗价值。

    方法  回顾性分析20061月至20117月间接受内镜下检查并获得病理确诊的胃肠道神经鞘瘤13例。

    结果   13例患者中8例位于胃,3例位于食管,2例位于结肠。超声内镜检查发现神经鞘瘤位于固有肌层,超声表现主要为低回声。12例接受内镜下治疗,11例患者在内镜下成功接受治疗,完整切除肿瘤,完整切除率为(91.7%)。其中6例行内镜黏膜下挖除术治疗,4例行内镜全层切除术治疗,1例食管神经鞘瘤行内镜经黏膜下隧道切除术治疗。1例食管病变由于肿瘤巨大(肿瘤最大径4.7cm,内镜部分切除病灶后,基底部仍较深,无法完整切除,终止内镜手术,转胸外科手术治疗。所有病例术后未出现胃肠道出血、腹膜炎体征和腹腔脓肿等并发症。平均随访时间(23.3±10.8)个月(6~36个月),在随访过程中未发现肿瘤复发或转移。

    结论   内镜及内镜超声有助于辅助诊断胃肠道神经鞘瘤并提供治疗指导,内镜下治疗对于胃肠道神经鞘瘤是一种安全、有效的方法。

    【关键词】 神经鞘瘤;胃肠道;黏膜下肿瘤;内镜黏膜下挖除术;内镜全层切除术;内镜经黏膜下隧道切除术


     

    Abstract Objective   To study the diagnostic and therapeutic value of endoscopy for gastrointestinal (GI) schwannoma. Methods   We retrospectively studied data of 13 patients who underwent endoscopy and were confirmed as having GI schwannoma by pathology in our hospital during January 2006 and July 2011. Result   Schwannoma of 8 patients located in stomach, 3 in esophagus and 2 in colon. Endoscopic ultrasonography showed schwannoma originated from muscularis propria, characterized by hypoecho. Twelve patients received endoscopic treatment, and 11 were successfully removed. The en bloc resection rate was 91.7%. Among them, 6 were treated by endoscopic submucosal excavation, 4 by endoscopic full-thickness resection and one by submucosal tunnel endoscopic resection. Another patient with schwannoma located in esophagus with a maximum diameter of 4.7cm was transferred to thoracic surgery since the tumor had a wide base even after partial resection. No bleeding, inflammation or abscess occurred. The average follow-up time was 23.3±10.8 months (range, 6~36 months). No metastasis or recurrence was found during follow-up. Conclusion   Endoscopy and endoscopic ultrasonography, safe and efficacious, are valuable for the diagnosis and treatment of GI schwannoma.

    Key words

    Schwannoma; Gastrointestinal tract; Submucosal tumor; Endoscopic submucosal excavation (ESE); Endoscopic full-thickness resection (EFR); endoscopic tunnelling submucosal resection (STER)

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个人资料
    周平红 单位:复旦大学附属中山医院
    所属科室:消化科
    出生:1916-12-01
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