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

Submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors

摘要:

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。

Abstract:

Abstract: 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.