内镜经黏膜下隧道肿瘤切除术治疗食管贲门周围黏膜下肿瘤的疗效分析

Curative effect analysis of submucosal tunnelling endoscopic resection on submucosal tumors of esophagus or cardia

摘要:

摘要：目的??探讨内镜经黏膜下隧道肿瘤切除术（STER）治疗食管贲门周围黏膜下肿瘤（SMT）的临床效果及安全性。方法 收集2012年9月－2018年6月在南京医科大学附属南京医院内镜中心采用STER治疗的50例食管贲门周围SMT患者的临床资料，并进行分析。结果 50例患者均完成STER。食管病变33例，贲门周围、胃底病变17例，1例病变为2个瘤体，其他均为单个瘤体。成功切除所有SMT，一次性完整切除率96.0%，手术时间32～115?min，平均（54.0±24.5）min，完整缝合创面所需金属夹4～8枚，平均（5.6±2.1）枚。术后瘤体直径0.8～3.3?cm，平均（1.6±0.4）cm。术后经常规病理及免疫组化染色确诊为平滑肌瘤40例（80.0%），间质瘤7例（14.0%），食管支气管源性囊肿2例（4.0%），钙化性纤维性肿瘤1例（2.0%），切缘均为阴性。4例术中发生穿孔，3例术中发生皮下气肿，3例术后出现发热，均经保守治疗痊愈。住院时间6～15?d，平均（7.8±3.7）d。结论 STER对食管贲门周围SMT有较高的完整切除率，且手术创伤小，恢复快，并发症较少，住院时间较短。

Abstract:

Abstract: Objective?To investigate the efficacy and safety of submucosal tunneling endoscopic resection (STER) in treatment of submucosal tumors of esophagus and cardia.?Methods?Clinical data of 50 patients with SMTs of esophagus and cardia treated with STER from Septemper 2012 to June 2018 were collected and analyzed.?Results?50 cases were completed with STER. There were 33 cases of esophageal lesions, 17 cases of cardiac and gastric fundus lesions, 1 of which had 2 tumors, and the others had single tumor. All these lesions were successfully resected by STER with en bloc resection rate of 96.0%. The operation time was 32?~?115 min, average (54.0?±?24.5) min. The submucosal tunnel entrance was sutured by 4?~?8 metal clips. The average was (5.6?±?2.1) pieces. The postoperative tumor diameter ranged from 0.8?~?3.3 cm, average (1.6?±?0.4)?cm. 40 cases (80.0%) were confirmed as leiomyoma by routine pathology and immunohistochemical staining postoperative speimens, 7 cases (14.0%) were stromal tumor, 2 cases (4.0%) were esophageal bronchogenic cyst, and 1 case (2.0%) was calcified fibrous tumor, all the cutting edges were negative. 4 patients developed gastrointestinal perforation during operation, 3 patients developed subcutaneous emphysema during operation, and 3 patients developed fever after operation, all of which were cured by conservative treatment. The hospital stay was 6?~?15 days, the average was (7.8?±?3.7) days. ?Conclusion?STER method has a high complete resection rate for the treatment on SMTs of esophagus and cardia, with small trauma and quick recovery, and has short duration of hospital stay and less complications.