内镜经黏膜下隧道肿瘤切除术治疗上消化道黏膜下肿瘤的临床研究
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摘要
目的探讨内镜经黏膜下隧道肿瘤切除术(STER)治疗上消化道黏膜下肿瘤(SMT)的疗效及安全性。方法回顾性分析2014年3月-2017年12月在该院经普通内镜、超声内镜(EUS)、CT诊断为上消化道SMT并接受STER治疗的32例患者的临床资料,分析病变起源、大小、病理、手术时间和术后并发症等。结果 32例上消化道SMT,24例来源于固有肌层,8例来源于黏膜下层,单瘤体31例,双瘤体1例,均由STER完整切除,切除成功率100.0%。肿瘤直径0.60～2.50 cm,平均1.24 cm。手术时间(黏膜切开至手术切口缝合完毕)20.00～120.00 min,平均41.60 min。术中使用钛夹4～20枚,平均5.9枚。术后病理:平滑肌瘤26例次,胃肠道间质瘤5例次,神经鞘瘤1例次,脂肪瘤1例次。术后发生皮下气肿1例,气胸1例,胸骨后疼痛21例,无迟发性消化道出血、消化道瘘和继发性胸腹腔感染发生。结论 STER是一种安全有效的治疗SMT的方法,可完整切除病灶,具有手术时间短、创伤小、恢复快的优势,近期疗效肯定,远期疗效尚需进一步随访。
Objective To explore the clinical efficacy and security of submucosal tunneling endoscopic resection(STER) in treatment of upper gastrointestinal submucosal tumors(SMT). Methods Clinical data of 32 cases that diagnosed as SMTs by endoscope, endoscopic ultrasonography and CT in the upper gastrointestinal and treated with STER from March 2014 to December 2017 were analyzed retrospectively. Their lesion origin, size, pathology, operation time, complications were involved. Results Among the 32 cases, 24 origined from muscularis propria layer, 8 from submucosal layer. They included 31 single tumors and 1 double tumors. All of the 32 cases were completely resected by STER. The mean size of the tumors was 1.24 cm(range 0.60 ～ 2.50 cm). The mean operation time of STER was 41.6 min(range 20.00 ～ 120.00 min). During the procedure, a mean number of 5.9(range 4 ～ 20) hemostatic clips were used to suture the mucosal incision. Pathological results showed that the tumors were leiomyoma(n = 26), gastrointestinal stromal tumors(n = 5), neurilemmoma(n = 1), lipoma(n = 1). The complications postoperation were subcutaneous emphysema(n = 1), pneumothorax(n = 1), retrosternal pain( n = 21). No submucosal hematoma, infection or digestive tract fistula occured. Conclusion STER is a safe and effective way to treat SMTs. It can completely remove lesions, and has advantages of short operative time, small trauma and quick recovery. The short-term curative effect is positive, and long-term effect needs further follow-up.
Objective To explore the clinical efficacy and security of submucosal tunneling endoscopic resection(STER) in treatment of upper gastrointestinal submucosal tumors(SMT). Methods Clinical data of 32 cases that diagnosed as SMTs by endoscope, endoscopic ultrasonography and CT in the upper gastrointestinal and treated with STER from March 2014 to December 2017 were analyzed retrospectively. Their lesion origin, size, pathology, operation time, complications were involved. Results Among the 32 cases, 24 origined from muscularis propria layer, 8 from submucosal layer. They included 31 single tumors and 1 double tumors. All of the 32 cases were completely resected by STER. The mean size of the tumors was 1.24 cm(range 0.60 ～ 2.50 cm). The mean operation time of STER was 41.6 min(range 20.00 ～ 120.00 min). During the procedure, a mean number of 5.9(range 4 ～ 20) hemostatic clips were used to suture the mucosal incision. Pathological results showed that the tumors were leiomyoma(n = 26), gastrointestinal stromal tumors(n = 5), neurilemmoma(n = 1), lipoma(n = 1). The complications postoperation were subcutaneous emphysema(n = 1), pneumothorax(n = 1), retrosternal pain( n = 21). No submucosal hematoma, infection or digestive tract fistula occured. Conclusion STER is a safe and effective way to treat SMTs. It can completely remove lesions, and has advantages of short operative time, small trauma and quick recovery. The short-term curative effect is positive, and long-term effect needs further follow-up.
引文
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[8]张彩凤,夏永华,姬娟娟,等.隧道技术治疗食管中下段隆起性病变24例的临床研究[J].中国内镜杂志,2016,22(3):72-75.ZHANG C F,XIA Y H,JI J J,et al.Tunnel technology in treatment of esophageal eminence lesions(24cases)[J].China Journal of Endoscopy,2016,22(3):72-75.Chinese
[9]徐丽霞,梁玮,邓万银,等.经黏膜下隧道内镜肿瘤切除术治疗食管固有肌层肿瘤[J].中华实验外科杂志,2014,31(12):2891-2893.XU L X,LIANG W,DENG W Y,et al.Submucosal tunneling endoscopic resection for esophageal tumors originated form muscularis propria[J].Chinese Journal of Experimental Surgery,2014,31(12):2891-2893.Chinese
[10]阮荣蔚,王实,陶亚利,等.内镜经黏膜下隧道肿瘤切除术治疗食管固有肌层肿瘤26例[J].临床荟萃,2015,30(8):895-898.RUAN R W,WANG S,TAO Y L,et al.Submucosal tunneling endoscopic resection for submucosal tumor originating from muscularis propria layer of esophagus:a report of 26 cases[J].Clinical Focus,2015,30(8):895-898.Chinese
[11]LIU B R,SONG J T,KONG L J,et al.Tunneling endoscopic muscularis dissection for subepithelial tumors originating from the muscularis propria of the esophagus and gastric cardia[J].Surgical Endoscopy and Other Interventional Techniques,2013,27(11):4354-4359.
[12]刘德良,谭玉勇,周雨迁,等.经黏膜下隧道内镜切除术治疗上消化道固有肌层肿瘤的临床应用[J].中华消化杂志,2014,34(12):840-842.LIU D L,TAN Y Y,ZHOU Y Q,et al.The clinical application of tunneling endoscopic resection under submucosal treat for muscularis propria tumors of upper digestive tract[J].Chinese Journal of Digestion,2014,34(12):840-842.Chinese
[13]TAN Y,LV L,DUAN T,et al.Comparison between submucosal tunneling endoscopic resection and video-assisted thoracoscopic surgery for large esophageal leiomyoma originating from the muscularis propria layer[J].Surgical Endoscopy and Other Interventional Techniques,2016,30(7):3121-3127.
[2]徐美东,张晨.隧道内镜技术在消化道疾病中的应用价值[J].中华临床医师杂志:电子版,2013,7(20):9027-9030.XU M D,ZHANG C.The application value of tunnel endoscopy in digestive tract diseases[J].Chinese Journal of Clinicians:Electronic Edition,2013,7(20):9027-9030.Chinese
[3]周平红,姚礼庆,徐美东,等.内镜黏膜下剥离术治疗消化道固有肌层肿瘤[J].中华消化内镜杂志,2008,25(1):22-25.ZHOU P H,YAO L Q,XU M D,et al.Endoscopic submucosal dissection for the treatment of gastrointestinal submucosal tumors originated from the muscularis propria layer layer[J].Chinese Journal of Digestive Endoscopy,2008,25(1):22-25.Chinese
[4]周平红,姚礼庆,秦新裕,等.无腹腔镜辅助的内镜全层切除术治疗源于固有肌层的胃黏膜下肿瘤[J].中华消化内镜杂志,2009,26(12):617-621.ZHOU P H,YAO L Q,QIN X Y,et al.Endoscopic full-thickness resection without laparoscopic assistance for gastric submucosal tumors originated from muscularis propria layer[J].Chinese Journal of Digestive Endoscopy,2009,26(12):617-621.Chinese
[5]HE G Q,WANG J H,CHEN B L,et al.Feasibility of endoscopic submucosal dissection for upper gastrointestinal submucosal tumors treatment and value of endoscopic ultrasonography in preoperation assess and post-operation follow-up:a prospective study of 224 cases in a single medical center[J].Surgical Endoscopy and Other Interventional Techniques,2016,30(10):4206-4213.
[6]徐美东,姚礼庆,周平红,等.经黏膜下隧道内镜肿瘤切除术治疗源于固有肌层的上消化道黏膜下肿瘤初探[J].中华消化内镜杂志,2011,28(11):606-610.XU M D,YAO L Q,ZHOU P H,et al.Submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors originating from muscularis propria layer[J].Chinese Journal of Digestive Endoscopy,2011,28(11):606-610.Chinese
[7]SONG S,WANG X,ZHANG S,et al.Efficacy and complications of submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors and exploration for influencing factors[J].Zeitschrift Fur Gastroenterology,2018,56(4):365-373.
[8]张彩凤,夏永华,姬娟娟,等.隧道技术治疗食管中下段隆起性病变24例的临床研究[J].中国内镜杂志,2016,22(3):72-75.ZHANG C F,XIA Y H,JI J J,et al.Tunnel technology in treatment of esophageal eminence lesions(24cases)[J].China Journal of Endoscopy,2016,22(3):72-75.Chinese
[9]徐丽霞,梁玮,邓万银,等.经黏膜下隧道内镜肿瘤切除术治疗食管固有肌层肿瘤[J].中华实验外科杂志,2014,31(12):2891-2893.XU L X,LIANG W,DENG W Y,et al.Submucosal tunneling endoscopic resection for esophageal tumors originated form muscularis propria[J].Chinese Journal of Experimental Surgery,2014,31(12):2891-2893.Chinese
[10]阮荣蔚,王实,陶亚利,等.内镜经黏膜下隧道肿瘤切除术治疗食管固有肌层肿瘤26例[J].临床荟萃,2015,30(8):895-898.RUAN R W,WANG S,TAO Y L,et al.Submucosal tunneling endoscopic resection for submucosal tumor originating from muscularis propria layer of esophagus:a report of 26 cases[J].Clinical Focus,2015,30(8):895-898.Chinese
[11]LIU B R,SONG J T,KONG L J,et al.Tunneling endoscopic muscularis dissection for subepithelial tumors originating from the muscularis propria of the esophagus and gastric cardia[J].Surgical Endoscopy and Other Interventional Techniques,2013,27(11):4354-4359.
[12]刘德良,谭玉勇,周雨迁,等.经黏膜下隧道内镜切除术治疗上消化道固有肌层肿瘤的临床应用[J].中华消化杂志,2014,34(12):840-842.LIU D L,TAN Y Y,ZHOU Y Q,et al.The clinical application of tunneling endoscopic resection under submucosal treat for muscularis propria tumors of upper digestive tract[J].Chinese Journal of Digestion,2014,34(12):840-842.Chinese
[13]TAN Y,LV L,DUAN T,et al.Comparison between submucosal tunneling endoscopic resection and video-assisted thoracoscopic surgery for large esophageal leiomyoma originating from the muscularis propria layer[J].Surgical Endoscopy and Other Interventional Techniques,2016,30(7):3121-3127.