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*

Submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors originating from muscularis propria layer*

摘要:

摘要：目的 评价内镜经黏膜下隧道肿瘤切除术（STER）治疗来源于固有肌层的上消化道黏膜下肿瘤（SMT）的疗效和安全性。方法 回顾性分析在该院应用STER治疗的来源于固有肌层的27处SMT的临床病理资料，并应用汉密尔顿焦虑量表评分评估患者治疗前后的心理状况。结果 共26例27处SMT，仅有1例食管并发2处SMT。年龄31～70岁，平均（49.9±9.8）岁。食管13处，贲门处病变13处，胃底体交界1处，瘤体直径大小为1.0～6.0cm，平均（2.0±1.1）cm，STER成功切除所有SMT，一次性完整切除率92.6%，切除时间11～163min，平均（51.0±35.7）min，钛夹缝合时间1～11min。术后病理诊断为平滑肌瘤21处（77.8%），间质瘤6处（22.2%，食管1处，胃5处），且均为极低危险度（直径1.0～1.8cm，核分裂像<5个/50HPF）。术后发生纵隔气肿1例，肺炎3例，均保守治疗痊愈，随访24～60个月，无复发或残余病变。随访期间为患者做汉密尔顿焦虑量表评价，在治疗前8例可能有焦虑（30.8%），5例肯定有焦虑（19.2%），1例在患病前患有焦虑，发现病变后焦虑症状加重，有明显焦虑。在内镜成功切除肿瘤后，患者焦虑明显好转。结论 STER治疗来源于固有肌层的一些上消化道SMT，既一次性完整切除病变，也治疗了患者因该疾病引发的焦虑，是一种安全、可行、有效的治疗方法。

Abstract:

Abstract: Objective To evaluate the efficiency and safety of submucosal tunneling endoscopic resection (STER) for upper gastrointestinal submucosal tumor (SMT) originating from the muscularis propria (MP) layer.Methods Clinicopathological data of 27 cases with upper gastrointestinal SMT originating from the MP layer treated with STER were analyzed retrospectively. Hamilton Anxiety Scale was used to assess the psychological status of patients before and after treatment.Results There were 26 patients and 27 cases. Only 1 patient had 2 cases of esophageal SMT. The age ranged from 31~70 (mean 49.9±9.8) years old. Of the 27 SMTs, 13 were located at the esophagus, 13 at gastric cardia and 1 at the gastric fundus and body junction. The diameters of the tumors were 1.0~6.0 (mean 2.0±1.1) cm. All these lesions were successfully resected by STER with an en bloc resection rate of 92.6%. The procedure time was 11~163 min, mean (51.0±35.7) min, and the time used to close the mucosal incision site was 1~11 min. Pathological examination showed that the lesions were leiomyomas (n=21, 77.8%), stromal tumors (n=6, 22.2%; 1 was at esophagus, 5 were at stomach, 1.0~1.8cm), and they were all extremely low risk stromal tumors (1.0~1.8cm, mitotic figures <5/50HPF). Both lateral and vertical margins were negative in all the cases. 1 patient developed mediastinal emphysema pneumothorax and 3 pneumonia after operation. All of them recovered uneventfully after conservative treatments. No tumor residual or recurrence was found during the follow up (range, 24~60 months). During the follow-up period, the Hamilton Anxiety Scale was made for the patients. Before the treatment, 8 people may have anxiety (30.8%), 5 people had anxiety (19.2%), 1 people had anxiety before the illness, and the anxiety symptoms were aggravated after the lesion found. After endoscopic resection, the patient’s anxiety improved significantly.ConclusionsSTER was a safe, effective therapy for appropriate lesions in the MP layer of the upper gastrointestinal SMT, which completely removed lesions and treated patients’ anxiety.