超声微探头联合多环黏膜套扎切除术治疗食管黏膜下肿瘤的临床研究

Clinical study of ultrasound microprobe combined with endoscopic multi-band mucosectomy in the treatment of esophageal submucosal tumors

摘要:

目的 探讨超声微探头联合内镜下多环黏膜套扎切除术（EMBM）治疗食管黏膜下肿瘤（SMTs）的可行性、安全性、有效性和经济性。方法 选择2013年1月－2019年6月103例在安徽医科大学第二附属医院门诊行超声微探头检查、证实起源于黏膜层及黏膜下层且直径小于2 cm的食管黏膜下隆起患者，均入院行EMBM治疗，回顾性分析该类患者的临床资料和手术资料，观察记录手术时间、手术并发症和整块切除率，随访术后有无复发或转移，总结EMBM的治疗效果。结果 103例患者均顺利完成内镜下治疗，98例（95.15%）成功予以EMBM切除，3例（2.91%）行结扎术未予以电切，2例（1.94%）术中改为内镜黏膜下隧道肿瘤切除术（STER）。整块切除95例（92.23%）。平均手术时间（30.2±10.7）min。2例切除术后创面渗血明显，予以氩离子束凝固术（APC）和电热活检钳成功止血。无穿孔、迟发性出血和操作相关死亡病例发生。术后病理与术前超声微探头诊断具有良好的一致性（P < 0.01）。术后平均住院时间为（5.0±2.1）d。随访期间，无1例出现复发。结论 EMBM对浅层的食管小SMTs具有较高的整块切除率，无严重并发症，超声微探头联合EMBM治疗食管小SMTs是安全有效且经济可行的方法。

Abstract:

Objective To investigate the feasibility, safety, effectiveness and economy of ultrasound microprobe combined with endoscopic multi-band mucosectomy (EMBM) in the treatment of esophageal submucosal tumors (SMTs).Method A retrospective analysis of 103 patients from January 2013 to June 2019. Ultrasound microprobes confirmed that the esophageal submucosal tumors originated in the mucosa and submucosa with a diameter of less than 2 cm was admitted to the hospital for EMBM treatment. Collect and analyze the clinical data and surgical data of the patients, observe and record the operation time, surgical complications, the overall resection rate, and follow-up after the recurrence or metastasis, summarize the therapeutic efficacy of EMBM.Results Endoscopic treatment was successfully performed in 103 patients, 98 patients (95.15%) were successfully treated with EMBM, 3 patients (2.91%) underwent ligation without electrotomy, and 2 patients (1.94%) were switched to Endoscopic submucosal tunnel tumor resection (STER). A total of 95 cases (92.23%) achieved monolithic resection. The average operation time was (30.2 ± 10.7) min. The bleeding of 2 cases was obvious after resection, and argon ion coagulation and electrothermal biopsy forceps were successfully used to stop bleeding. No perforation, late bleeding, or operation-related death occurred. Postoperative pathology was in good agreement with preoperative ultrasound microprobe diagnosis (P < 0.01). The average hospital stay was (5.0 ± 2.1) d. During the follow-up period, no relapse occurred.Conclusion EMBM has a high monolithic resection rate for small superficial submucosal bulges without serious adverse complications. Ultrasound microprobe combined with EMBM for the treatment of small esophageal SMTs is a safe, effective, economically and feasible method.