Study The Value Of Miniprobe Endoscopic Ultrasonography In The Diagnosis And Treatment Of Leiomyoma Of Esophagus

Background:Leiomyomas are the commonest benign tumors of the esophagus representing 52.1-83.3% of all benign tumors of the esophagus. Applied esophageal barium meal, gastroscope and computed tomography(CT) to diagnose previously, the rate of diagnosis was low,notwithstanding we could see morphosiS, size and feel its texture under gastroscope,but we couldn't judge its tissue origin, property and couldn't get submucous specimen block using biopsy forceps,so its detection rate of pathologic diagnosis was low. Since the miniprobe endoscopic ultrasonography used in clinical, we can determine the shape of esophageal submucosal lesion, size, tissue origin, nature, the detection rate of esophageal leiomyoma greatly increased. At present studying mucosal protruding lesions is much, but purely study esophageal leiomyoma and miniprobe endoscopic ultrasound-guided treatment of esophageal leiomyoma, which is a safe and effective, about related reports is low. Objective:To study clinical feature of esophageal leiomyoma and the clinical value of miniprobe endoscopic ultrasonography in the diagnosis and treatment of esophageal leiomyoma, its therapeutic effective and safety.Object:A total of 342 patients who were diagnosed esophageal leiomyoma by MEUS, who were diagnosed mucosal protruding lesions by gastroscope and couldn't judge its property, male 188 and female 154, aged from 21 to 78 years with a median age of 51 years, were enrolled in this study in the first affiliated hospital of medical school of Zhejiang university from October 2004 to July 2010.Methods:Clinical data, results of MEUS diagnosis, clinical treatment and results of pathologic diagnosis were analyzed in 342 patients who were diagnosed esophageal leiomyoma by MEUS.All patients were medical follow up, to visit healing or not after treatment and to visit those esophageal leiomyoma changing who didn't accept treatment. SPSS13.0 software was used to analysis all data which were input computer Microsoft excel 2003 and measurement data used mean±SD to express, count data used rate or constitution ratio to express. And paired count data selected x2 test, P<0.05 suggested significant differences in results. Results:1. Age features of patients who were diagnosed esophageal leiomyoma by MEUS, there are 7 cases whose age younger than 30 years, there are 272 cases whose age from 30 to 60 years, there are 63 cases whose age over 60 years.2. Growth features of esophageal leiomyoma, there are 322 cases who have solitary leiomyoma, there are 20 cases who have multiple leiomyoma.3. Distribution features of esophageal leiomyoma,the number of esophageal leiomyoma are 365,with position classification,95 reside in superior segmental esophagus,108 reside in middle piece of esophagus,162 reside in inferior segmental esophagus; with direction classification,77 reside in anterior wall of esophagus,98 reside in posterior wall of esophagus,67 reside in right wall of esophagus,123 reside in left wall of esophagus; with size classification,306 smaller than lcm,47 size from lcm to 2cm,12 larger than 2cm; with origin classification,56 origin from stratum submucosa,245 origin from lamina muscularis mucosae,64 origin from muscularis propria.4. Treatment of esophageal leiomyoma,92 cases who accepted treatment,88 of them accepted high frequency coagulating therapy,3 of them accepted argon plasma coagulating therapy,1 of them accepted loop ligature,no patients happened massive hemorrhage or perforation in operation, re-examination of gastroscope at two months after operation,all wound surface of esophagus well healing.250 cases didn't accept treatment, re-examination of MEUS every 1-6 month, one of them accepted frequency coagulating therapy notwithstanding the size and origin of leiomyoma didn't change,who were diagnosed esophageal leiomyoma and wound surface of esophagus well healing after operation,other 249 cases whose size,origin of leiomyoma didn't change, continuing follow-up investigation.5. Comparing MEUS diagnosis and pathological diagnosis, The number of pathological specimen are 76 after surgery,69 of which are leiomyoma,5 of which are cyst,1 of which is interstitial tumor and 1 of which is hemangioma with pathologic diagnosis. Diagnostic accuracy of EUS was 90.79%(69/76).6. Clinical features of esophageal leiomyoma by endoscopic ultrasound diagnosis of pathologically confirmed.(1) The number of cases were 69,40 cases were male, female 29, age 26 to 74 years with a median age of 49 years.(2) Size 0.25-3.0cm, an average of 0.54±0.19 cm.(3) Growth 64 cases of single and multiple in 5 cases.(4) Distribution the upper esophagus in 27 cases,19 cases of middle and lower segment 23.(5) Position a total of 74 esophageal leiomyomas,20 in the esophageal anterior wall,21 in the esophageal posterior wall,21 in the left wall of the esophagus and 12 in the right side of esophageal wall.(6) Origin muscularis mucosa in 65 cases (94.2%), submucosa in 3 cases (4.35%), natural muscle in 1 case (1.45%)Conclusions:Esophageal leiomyoma in single-based, more men than women, more common in middle-aged, mostly located on the left wall of the lower esophagus, the main source of muscularis mucosa, and the proportion of muscularis mucosa of esophageal upper section is higher than lower esophagus, and of submucosa, muscularis propria is much lower than lower esophagus, the majority of which less than lcm, gender between origin of Esophageal leiomyoma are not different. MEUS have a high diagnosis rate of esophageal leiomyoma, it is effective and safe that miniprobe endoscopic ultrasound-guided endoscopic therapy of esophageal leiomyoma according to MEUS determining the origin of esophageal leiomyoma.