【摘要】：目的：探討內(nèi)鏡下不同方法治療食管隆起性病變（esophageal protruded lesions，EPL）的臨床療效及并發(fā)癥。 方法：選取2011年9月至2012年12月經(jīng)胃鏡、超聲胃鏡、CT診斷為食管隆起性病變并采用內(nèi)鏡下黏膜切除術(shù)（EMR）、內(nèi)鏡黏膜下剝除術(shù)（ESD）、及黏膜下隧道內(nèi)鏡切除術(shù)(STER)切除病灶患者共66例，其中男性38例，女性28例，年齡33-72歲。對(duì)患者臨床資料、術(shù)后跟蹤隨訪情況進(jìn)行研究分析。 結(jié)果：1、胃鏡下發(fā)現(xiàn)病灶共68處，完整切除66處，2處手術(shù)中發(fā)現(xiàn)為腔外病變，停止內(nèi)鏡操作。66處病灶位于食管上段21處（31.82%），中段23（34.85%）處，下段22處（33.33%），均行內(nèi)鏡下順利完整切除，未出現(xiàn)穿孔、大出血、氣胸、食管狹窄等嚴(yán)重并發(fā)癥；其中EMR切除37處，ESD切除14處，STER切除15處；術(shù)后組織病理學(xué)判定完全切除，EMR組切除病灶最大徑平均為6.11±3.47mm，ESD組切除標(biāo)本最大徑平均值為14.07±9.56mm，，STER組切除標(biāo)本最大徑平均值為15.31±6.28mm。ESD治療組切除標(biāo)本最大徑大于EMR組，差異有統(tǒng)計(jì)學(xué)意義（P0.001）；STER組切除標(biāo)本最大徑大于EMR組，差異有統(tǒng)計(jì)學(xué)意義（P0.001）。三組切除病灶的分布部位差異有統(tǒng)計(jì)學(xué)意義（P=0.001）。 2、組織病理學(xué)結(jié)果顯示良性病變60例，其中平滑肌瘤46例，間質(zhì)瘤2例，囊腫3例，息肉樣增生2例，非息肉樣增生4例，顆粒細(xì)胞瘤1例；非典型增生6例，其中低級(jí)別上皮內(nèi)瘤變2例，高級(jí)別上皮內(nèi)瘤變4例。非典型增生者隨訪時(shí)間為8±6.5月，均未見復(fù)發(fā)。 3、術(shù)后共有35例患者進(jìn)行1個(gè)月的隨訪，其中EMR組隨訪15例，ESD組隨訪10例，STER組隨訪10例。EMR治療組中5例（33.33%）患者原病灶切除處出現(xiàn)食管黏膜增生，2例（13.33%）患者食管黏膜出現(xiàn)疤痕；ESD治療組中3例（30%）患者原病灶切除處出現(xiàn)食管黏膜增生，7例（70%）患者食管黏膜出現(xiàn)瘢痕；STER治療組中9例（90%）患者術(shù)后出現(xiàn)食管黏膜增生，1例（10%）患者食管黏膜出現(xiàn)疤痕；所有術(shù)后出現(xiàn)疤痕患者均未引起食管狹窄。ESD與STER兩組術(shù)后食管黏膜改變存在統(tǒng)計(jì)學(xué)差異（P=0.02），ESD術(shù)后原病灶處食管黏膜易形成瘢痕，而STER術(shù)后食管黏膜增生明顯。 結(jié)論：食管隆起性病變可見于食管任何部位，EMR、ESD以及STER是目前治療該類病變安全有效的方法，但ESD、STER術(shù)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 鹵9.56mmSter group was 15.31 鹵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 鹵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 鹵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.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R571

【參考文獻(xiàn)】

相關(guān)期刊論文 前5條

1 江華;令狐恩強(qiáng);孫剛;;食管良性狹窄動(dòng)物模型的建立及病理學(xué)分析[J];解放軍醫(yī)學(xué)雜志;2006年11期

2 熊觀瀛;王翔;王敏;文衛(wèi);范志寧;;黏膜下激素注射聯(lián)合擴(kuò)張治療難治性食管良性狹窄[J];中國內(nèi)鏡雜志;2009年01期

3 辛培玲;弭希峰;;擴(kuò)張置管治療癌性復(fù)雜性食管狹窄和瘺51例分析[J];腫瘤研究與臨床;2006年04期

4 Seong Hwan Kim;Jeong Seop Moon;Young Hoon Youn;Ki Myung Lee;Sung Joon Lee;;Management of the complications of endoscopic submucosal dissection[J];World Journal of Gastroenterology;2011年31期

5 Bao-Guo Bu;En-Qiang Linghu;Hui-Kai Li;Xiao-Xiao Wang;Rong-Bin Guo;Li-Hua Peng;;Influence of endoscopic submucosal dissection on esophageal motility[J];World Journal of Gastroenterology;2013年29期

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