经黏膜下隧道内镜切除术治疗食管胃黏膜下肿瘤的效果观察
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摘要
目的探讨食管胃黏膜下肿瘤应用黏膜下隧道内镜切除术(submucosal tunnel endoscopic resection, STER)治疗的效果及安全性。方法 30例食管胃黏膜下肿瘤患者,均行STER治疗,记录肿瘤一次性完整切除率、手术时间、住院时间、术后并发症发生情况;分别于术后第1、3、6个月行胃镜检查,观察病灶创面愈合情况,有无病变残留及复发。结果 30例患者肿瘤一次性完整切除率为100%,手术时间(50.20±11.82)min,住院时间(10.50±4.50)d;术后发生气胸1例、皮下气肿3例、继发性肺部感染1例,均经保守治疗后好转出院;术后第1、3、6个月胃镜下见病灶创面愈合良好,无病变残留及复发。结论 STER治疗食管胃黏膜下肿瘤安全有效,并发症发生率低。
Objective To explore the effect and safety of submucosal tunnel endoscopic resection(STER) in the treatment of esophagogastric submucosal tumors. Methods Thirty patients with esophagogastric submucosal tumors underwent STER. The total tumor resection rate, operative time, hospital stay and postoperative complications were recorded. Gastroscopic follow-up was performed in 1, 3 and 6 months after operation to observe the healing of the wound, residual lesions and recurrence. Results The complete resection rate was 100% in 30 patients. The operative time was(50.20±11.82) min, and the hospital stay was(10.50±4.50) d. The postoperative complications included pneumothorax in 1 patient, subcutaneous emphysema in 3, and secondary pulmonary infection in 1, all of which were cured after conservative treatment. The 1-, 3-and 6-month follow-up showed good healing of wound, and neither residual lesions nor recurrence. Conclusion STER is safe and effective on esophagogastric submucosal tumors, with low incidence of complications.
Objective To explore the effect and safety of submucosal tunnel endoscopic resection(STER) in the treatment of esophagogastric submucosal tumors. Methods Thirty patients with esophagogastric submucosal tumors underwent STER. The total tumor resection rate, operative time, hospital stay and postoperative complications were recorded. Gastroscopic follow-up was performed in 1, 3 and 6 months after operation to observe the healing of the wound, residual lesions and recurrence. Results The complete resection rate was 100% in 30 patients. The operative time was(50.20±11.82) min, and the hospital stay was(10.50±4.50) d. The postoperative complications included pneumothorax in 1 patient, subcutaneous emphysema in 3, and secondary pulmonary infection in 1, all of which were cured after conservative treatment. The 1-, 3-and 6-month follow-up showed good healing of wound, and neither residual lesions nor recurrence. Conclusion STER is safe and effective on esophagogastric submucosal tumors, with low incidence of complications.
引文
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[19] CHEN T,ZHEN P H,CHU Y,et al.Long-term outcomes of submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors[J].Ann Surg,2017,265(2):363-369.
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[21] 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):898-899.
[22] 郭智慧,龚伟,彭阳,等.经口内镜黏膜下隧道肿瘤切除术切除食管固有肌层平滑肌瘤[J].南方医科大学,2011,31(12):2082-2084.
[2] 徐正元.内镜下黏膜切除术治疗食管黏膜下肿瘤48例分析[J].医药论坛杂志,2013,34(2):59-60.
[3] TANG X,REN Y,HUANG S,et al.Endoscopic submucosal tunnel dissection for upper gastrointestinal submucosal tumors originating from the muscularis propria layer:a single-center study[J].Gut Liver,2017,11(5):620-627.
[4] ZHOU J Q,TANG X W,REN Y T,et al.Endoscopic submucosal tunnel dissection of upper gastrointestinal submucosal tumors:a comparative study of hook knife vs hybrid knife[J].World J Gastroenterol,2017,23(10):1843-1850.
[5] LU J,JIAO T,ZHENG M,et al.Endoscopic resection of submucosal tumors in muscularis propria:the choice between direct excavation and tunneling resection[J].Surg Endosc,2014,28(12):3401-3407.
[6] ZHANG C,HU J W,CHEN T,et al.Submucosal tunneling endoscopic resection for upper gastrointestinal multiple submucosal tumors originating from the muscular propria layer:a feasibility study[J].Indian J Cancer,2015,51 Suppl2:e52-55.
[7] CHAI N,DU C,GAO Y,et al.Correction to:comparison between submucosal tunneling endoscopic resection and video-assisted thoracoscopic enucleation for esophageal submucosal tumors originating from the muscularis propria layer:a randomized controlled trial[J].Surg Endosc,2018,32(7):3373.
[8] ZHANG Y,YE L P,ZHOU X B,et al.Safety and efficacy of endoscopic excavation for gastric subepithelial tumors originating from the muscularis propria layer:results from a large study in China[J].J Clin Gastroenterol,2013,47(8):689-694.
[9] DU C,LINGHU E.Submucosal tunneling endoscopic resection for the treatment of gastrointestinal submucosal tumors originating from the muscularis propria layer[J].J Gastrointest Surg,2017,21(12):2100-2109.
[10] DU C,MA L,CHAI N,et al.Factors affecting the effectiveness and safety of submucosal tunneling endoscopic resection for esophageal submucosal tumors originating from the muscularis propria layer[J].Surg Endosc,2018,32(3):1255-1264.
[11] ZHOU D J,DAI Z B,WELLS M M,et al.Submucosal tunneling and endoscopic resection of submucosal tumors at the esophagogastric junction[J].World J Gastroenterol,2015,21(2):578-583.
[12] TAN Y,TANG X,GUO T,et al.Comparison between submucosal tunneling endoscopic resection and endoscopic full-thickness resection for gastric stromal tumors originating from the muscularis propria layer[J].Surg Endosc,2017,31(8):3376-3382.
[13] 齐志鹏,钟芸诗,周平红,等.上消化道不同部位黏膜下肿瘤的临床病理学特征[J].中华消化内镜杂志,2016,33(6):362-366.
[14] 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].Surg Endosc,2016,30(7):3121-3127.
[15] 周平红,钟芸诗,李全林,等.中国消化道黏膜下肿瘤内镜诊治专家共识(2018版)[J].中国实用外科杂志,2018,38(8):840-850.
[16] 张瑜,齐健,胡玲珍,等.经黏膜下隧道内镜肿瘤切除术治疗食管黏膜下肿瘤38例分析[J].胃肠病学和肝病学杂志,2018,27(7):739-742.
[17] 田雪丽,黄永辉,李渊,等.内镜经黏膜下隧道肿瘤切除术治疗源于固有肌层的上消化道黏膜下肿瘤[J].中国内镜杂志,2018,24(12):90-94.
[18] MAO X L,YE L P,ZHENG H H,et al.Submucosal tunneling endoscopic resection using methylene-blue guidance for cardial subepithelial tumors originating from the muscularis propria layer[J].Dis Esophagus,2017,30(3):1-7.
[19] CHEN T,ZHEN P H,CHU Y,et al.Long-term outcomes of submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors[J].Ann Surg,2017,265(2):363-369.
[20] 姜海行,覃山羽,黄杰安,等.经内镜黏膜下隧道肿瘤切除术治疗上消化道黏膜下肿瘤的的应用研究[J].微创医学,2013,8(6):663-664.
[21] 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):898-899.
[22] 郭智慧,龚伟,彭阳,等.经口内镜黏膜下隧道肿瘤切除术切除食管固有肌层平滑肌瘤[J].南方医科大学,2011,31(12):2082-2084.