内镜经黏膜下隧道肿瘤切除术治疗源于固有肌层食管黏膜下肿瘤的回顾性分析  

Submucosal tunneling endoscopic resection of esophageal submucosal tumors originating from the muscularis propria layer: A retrospective analysis

作　　者：闵寒[1,2] 陈志荣[1,2] 龚菲[1,2] 王皓[1,2] 周俊东[1,3] 陈巍峰[4] 

机构地区：[1]南京医科大学附属苏州医院,江苏省苏州市215001 [2]苏州市立医院东区消化内科,江苏省苏州市215001 [3]苏州市立医院东区肿瘤实验室,江苏省苏州市215001 [4]复旦大学附属中山医院内镜中心,上海市200032

出　　处：《世界华人消化杂志》2014年第7期915-919,共5页World Chinese Journal of Digestology

基　　金：国家自然科学基金资助项目;No.81372433;苏州市科教兴卫基金资助项目;No.SWKQ1026~~

摘　　要：目的:回顾性分析内镜经黏膜下隧道肿瘤切除术(submucosal tunneling endoscopic resection,STER)治疗来源于固有肌层食管黏膜下肿瘤(submucosal tumors,SMTs)的安全性和有效性.方法:选取2012-04/2013-08行STER治疗,来源于固有肌层食管SMTs的患者5例.具体步骤如下:(1)建立黏膜下隧道暴露肿瘤;(2)完整剥离肿瘤;(3)移除肿瘤,关闭隧道口.结果:采用STER成功切除所有黏膜下肿瘤,完整切除率100%;切除病灶直径1.0-2.5 cm,平均1.6 cm;操作时间80-138 min,平均108.6 min;住院天数5-7 d,平均5.8 d;关闭隧道口用金属钛夹5-9枚,平均7枚.术后病理诊断为平滑肌瘤4例,间叶源性肿瘤1例,切缘均为阴性.发生皮下气肿1例,予保守治疗好转.4例完成6 mo、1例完成12 mo随访,无一例出现病变残留或复发.结论:STER治疗来源于固有肌层的食管SMTs是安全有效的,值得临床推广并需进一步探究其适应症.AIM： To evaluate the safety and efficacy of submucosal tunneling endoscopic resection（STER） for esophageal submucosal tumors（SMTs） originating from the muscularis propria layer. METHODS： Between April 2012 and August 2013, 5 patients with esophageal SMTs originating from the muscularis propria layer were treated by STER. The key steps were as follows：（1） creating a submucosal tunnel to uncover the tumor;（2） resecting the tumor en bloc by endoscopic resection techniques; and（3） closing the mucosal incision site after the tumor was removed. RESULTS： STER was successfully performed in all 5 cases（success rate： 100%）. The mean tumor size was 1.6 cm（range, 1.0-2.5 cm）. The mean procedure time was 108.6 min（range, 80-138 min）. The average hospital stay was 5.8 d（range, 5-7 d）. The mean number of clips used was 7（5-9）. Pathological diagnosis of the tumors was leiomyoma（4/5） and mesenchymal tumor（1/5） with lateral and basal resection margins free of tumor tissue. During the procedure, one patient developed subcutaneous emphysema, who recovered after conservative treatment. No residual or recurrent tumors were detected during the 6-mo（4 patients） and 12-mo（1 patient） follow-up period. CONCLUSION： STER seems to be a safe and effective procedure for treatment of esophageal SMTs originating from the muscularis propria layer, but its indications need to be further investigated.

关 键 词：食管黏膜下肿瘤 内镜经黏膜下隧道肿瘤切除术 固有肌层 

分 类 号：R735.1[医药卫生—肿瘤]