内镜经黏膜下隧道肿瘤切除术治疗食管固有肌层肿瘤26例  

Submucosal tunneling endoscopic resection for submucosal tumor originating from muscularis propria layer of esophagus:a report of 26 cases

作　　者：阮荣蔚[1,2] 王实[2] 陶亚利[2] 毛建山[1] 俞江平[2] 刘永军[2] 朱舒文[2] 

机构地区：[1]浙江大学医学院附属第二医院消化科,浙江杭州310003 [2]浙江省肿瘤医院内镜中心,浙江杭州310022

出　　处：《临床荟萃》2015年第8期895-898,902,共5页Clinical Focus

摘　　要：目的探讨内镜经黏膜下隧道肿瘤切除术（submucosaltunneling endoscopic resection，STER）治疗食管固有肌层肿瘤的安全性与可靠性。方法回顾性分析行sTER治疗的26例食管固有肌层肿瘤患者的临床资料，评价治疗的可行性、安全性和疗效。结果26例食管固有肌层肿瘤患者行STER治疗，1次性完整切除25例，成功率为96．2％（25／26）。切除瘤体直径1．0～2．6cm，平均（1．7±0．5）cm，STER治疗时间33～157分钟，平均（63±23）分钟。术后并发纵隔和皮下气肿11例（42．3％），气胸2例（7．7％），气腹1例（3．8％），均经内科保守治疗后痊愈，无迟发性出血、食管瘘、纵隔感染等并发症发生。STER术后病理示平滑肌瘤21例，间质瘤3例，颗粒细胞瘤1例。术后所有患者定期参加随访（〉3个月），无复发及残留病例。结论STER技术治疗直径〈3．0cm的食管固有肌层肿瘤安全可靠，并可提供完整的病理学资料，值得临床应用与推广。Objective To assess the safety and reliability of submucosal tunneling endoscopic resection （STER） for the treatment of submucosal tumor originating from the muscularis propria layer of the esophagus. Methods Data of 26 patients with lesions in esophageal muscularis propria treated with STER were retrospected. Feasibility, safety and effects were evaluated accordingly. Results A total of 26 cases of submucosal tumor originating from the muscularis propria layer of the esophagus were treated by STER, 25 cases were en bloc resected, the successful rate was 96.2% （25/26）. The size of lesions ranged from 1.0 to 2.6 cm with a mean size of （1.7±0.5） cm. The mean STER procedure time was （63±23） min （ ranged from 33 to 157 min ）. During the procedure, subcutaneous and mediastinal emphysema occurred in eleven patients （42.3 % ）. Two patients （7.7%） developed pneumothorax, and other one （3.8%） developed pneumoperitoneum. All of them recovered after conservative treatment. No patient developed delayed hemorrhage, esophageal fistula or mediastinal infection after STER. The histological diagnoses were 21 leiomyomas, 3 gastrointestinal stromal tumors and 1 granulosa cell tumor. No residual or recurrent tumors were detected during the follow-up period （〉3 months）. Conclusion STER appears to be a safe, feasible and effective procedure for treatment of small （〈 3.0 cm） submueosal tumor originating from the muscularis propria layer of the esophagus. It can provide accurate histopathological evaluations and is a technique to be worth applying and popularizing.

关 键 词：食管肿瘤 内窥镜检查 黏膜下隧道肿瘤切除术 

分 类 号：R735.1[医药卫生—肿瘤]