摘要目的 评价超声内镜对食管平滑肌瘤的诊断及治疗中的价值.探讨内镜黏膜切除术(EMR)、内镜黏膜下剥离术(ESD)治疗食管平滑肌瘤的疗效和安全性.方法 对内镜检查中发现的40例食管黏膜下肿瘤行超声内镜检查,其中30例为起源于黏膜肌层的食管平滑肌瘤,4例为起源于同有肌层的食管平滑肌瘤.对30例起源于黏膜肌层的食管平滑肌瘤,根据病变大小决定行内镜下EMR或ESD治疗,完整切除病变.对4例起源于固有肌层的食管平滑肌瘤,考虑穿孔可能性大,未予内镜下治疗.结果 40例食管黏膜下肿瘤,病变直径0.4～2.5 cm(中位直径1.45 cm).24例行内镜下EMR治疗,6例病变直径超过1.5 cm行内镜下ESD治疗,ESD手术时间15～45 min(中位时间30min).2例术中出血较多.经内镜喷洒止血药物、电凝、氩离子束凝固治疗及金属钛夹钳夹止血,无术后出血,无ESD穿孔.所有EMR或ESD切除病变送检病理确诊,基底和切缘未见病变累及.术后1.5个月及6个月随访,创面愈合,无病变残留和复发.结论 超声内镜能够准确地诊断食管平滑肌瘤并指导其治疗.大多数食管平滑肌瘤的EMR治疗是简便和安全的.对于病灶较大、EMR难以完整切除的病变可行ESD治疗,也是安伞有效的,它可以完整切除食管病变,并提供完整的病理诊断资料.

abstractsObjective To evaluate the diagnostic value of endoscopic ultrasonography (EUS) and endoscopic therapies in esophageal leiomyoma under the guidance of EUS, and to assess the clinical efficacy and safety of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) for esophageal leiomyoma.Methods A total of 40 patients with submucosal tumors (SMT) of the esophagus diagnosed by endoscopy were examined by EUS.Of these patients, esophageal ieiomyoma was found deriving from muscularis mucosa in 30 and from proper muscle layer in 4.All muscularis mucosa-derived lesions were completely removed with EMR or ESD depending on tumor size, while the proper muscle layer- derived lesions did not receive endoscopic surgery due to a higher risk of esophageal perforation.Results The resected SMT sized 0.4-2.5 cm in diameter (mediam: 1.45 cm).Among the 40 lesions, 24 were successfully resected by EMR and 6 with diameter over 1.5 cm were resected by ESD.The mediam ESD procedure time was 30 rain (range 15 to 45 min).Two patients had massive hemorrhage during ESD, which could be controlled under gastroscopic spray of hemostatie agents, electric cautery, argon plasma coaqulation and titanic clip placement.None of the patients had delayed bleeding or perforation after ESD.Histological evaluation showed that the tunica of the tumors was intact, and beth the lateral and basal margins of the specimens were free of tumor cells.Follow-up at 1.5 and 6 months after ESD healing of artificial ulcer was confirmed with no residue or recurrence.Conclusions Esophageal leiomyoma can be definitely diagnosed by EUS and subjected to EUS-guided treatment.Most of esophageal leiomyoma may be resected simply and safely by EMR.For larger lesions that may be difficult to resect completely with EMR, ESD can be a safe and effective substitute, which yielded not only complete removal, but also complete information for pathological study.