隧道法内镜黏膜下肿物切除术治疗食管上段黏膜下肿瘤的疗效及影响因素分析

Efficacy of submucosal tunnel endoscopic resection for upper esophagus submucosal tumors and influencing factors

摘要:

目的 探索隧道法内镜黏膜下肿物切除术（STER）治疗起源于固有肌层（MP）的食管上段黏膜下肿瘤（SMT）的疗效及影响因素。方法 回顾性分析该院采用STER治疗的，起源于MP的41例食管上段SMT患者的临床资料。结果 病变距门齿22.0（20.0，23.0）cm，病变直径1.5（1.2，3.0）cm，长隧道STER（隧道长度 ≥ 3.0 cm）切除15例（36.6％），短隧道STER（隧道长度 < 3.0 cm）切除26例（63.4％），平均手术时间60.0（34.0，93.0）min。肿瘤整块切除率80.5％（33/41）。术中3例（7.3％）出现并发症。其中，隧道黏膜损伤2例（4.9％），大出血1例（2.4％）。术后皮下气肿4例（9.8％），高热3例（7.3％），均通过保守治疗好转，术后住院时间6.0（4.5，7.0）d。肿瘤长径 ≥ 3.0 cm组与肿瘤长径 < 3.0 cm组比较，手术时间长（P = 0.000），术后并发症多（P = 0.014），整块切除率低（P = 0.036）。短隧道组与长隧道组的肿瘤大小、肿瘤形状、手术时间、术中并发症、整块切除率、术后并发症和术后住院时间比较，差异均无统计学意义（P > 0.05）。病理诊断为平滑肌瘤39例，神经鞘瘤2例。术后随访（34.2±18.7）个月，均无肿瘤复发，无食管狭窄发生。结论 STER治疗起源于MP的食管上段SMT是安全有效的，尤其适用于长径 < 3.0 cm的食管SMT。短隧道STER治疗食管上段SMT的安全性也得到了初步证实。

Abstract:

Objective To evaluate the efficacy of submucosal tunnel endoscopic resection (STER) for upper esophagus submucosal tumors (SMT) originating from muscularis propria (MP) layer and the influencing factors.Methods Retrospectively analyzed the clinical data of 41 cases of upper esophagus SMT originating from MP layer treated with STER.Results The lesion was located 22.0 (20.0, 23.0) cm from the incisor and the length diameter was 1.5 (1.2, 3.0) cm. 15 cases (36.6%) underwent the long tunnel STER (tunnel length ≥ 3.0 cm), and 26 cases (63.4%) underwent the short tunnel STER (tunnel length < 3.0 cm). The operation time was 60.0 (34.0, 93.0) min, and the en bloc resection rate was 80.5% (33/41). There were 3 cases (7.3%) of intraoperative complications, including 2 cases (4.9%) of tunnel mucosal injury and 1 case (2.4%) of major bleeding. There were 4 cases (9.8%) of postoperative subcutaneous emphysema, 3 case (7.3%) of hyperthermia, all of which recovered through conservative treatment, and the postoperative hospital stay was 6.0 (4.5, 7.0) d. The operative time (P = 0.000) in the tumor length diameter ≥ 3.0 cm group was longer than that in the tumor length diameter < 3.0 cm group, the postoperative complications (P = 0.014) was more than that in the tumor length diameter < 3.0 cm group, and the en bloc whole resection rate (P = 0.036) in the tumor length diameter ≥ 3.0 cm group was lower than that in the tumor length diameter < 3.0 cm group. The difference of tumor size, tumor shape, operative time, intraoperative complications, en bloc resection rate, postoperative complications and postoperative hospital stay between the long tunnel STER group and short tunnel STER group were not statistically significant (P > 0.05). Pathology was diagnosed as leiomyomas in 39 cases and schwannomas in 2 cases. There was no tumor recurrence at the postoperative follow-up (34.2 ± 18.7) months, and no esophageal stricture occurred.Conclusion STER is safe and effective in treating upper esophagus SMT originating from MP layer without serious complications, especially for SMT with a length diameter < 3.0 cm. The safety and efficacy of short-tunnel STER for upper esophagus SMT have also been initially confirmed.