内镜经黏膜下隧道肿瘤切除术治疗食管黏膜下肿瘤的策略分析  

Analysis of submucosal tunneling endoscopic resection on treatment of esophageal submucosal tumors

作　　者：王伟[1] 施新岗[1] 金震东[1] 李兆申[1] 

机构地区：[1]第二军医大学附属长海医院消化内镜中心,上海200433

出　　处：《中华消化内镜杂志》2017年第10期695-698,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨内镜经黏膜下隧道肿瘤切除术（STER）治疗食管黏膜下肿瘤（SMT）的最佳指征。方法回顾性分析2013年5月至2014年8月在长海医院消化内镜中心接受STER治疗的67例食管SMT患者的临床资料，重点分析病灶特征与STER治疗成功率及手术并发症的关系。结果接受STER治疗的SMT以食管中下段为主，占89．6％（60／67）；病灶以腔内生长型为主，占95．6％（64／67）；病灶长径1～6em，平均（2．34±1．13）cm。STER隧道切口长度1—2cm，平均（1．19±0．37）cm，隧道长度2～7cm，平均（4．09±1．26）cm；术中隧道黏膜破损率为7．5％（5／67），肌层破损率为4．5％（3／67）；夹闭创面使用止血夹数量2～17枚，平均（8．79±3．39）枚；术中、术后均未出现严重并发症。STER手术成功率100％，其中病灶整块切除率为91．0％（61／67），整块取出率为83．6％（56／67）。当病灶长径〉3cm时病灶切除时间显著增加，而病灶整块切除率、整块取出率显著降低。结论STER是治疗食管SMT的有效术式，尤其适合起源于食管中下段且长径〈3cm的腔内生长型SMT。Objective To investigate the optimal indication of submucosal tunneling endoscopic resection （STER） in patients with esophageal submucosal tumor （SMT）. Methods Clinical data of 67 patients with esophageal SMT from May 2013 to August 2014 were summarized in the Digestive Endoscopy Center of Shanghai Changhai Hospital, and relationships between lesion features and success rate or complications of STER were analyzed. Results Of all 67 cases, 60 cases （ 89. 6%） located in the middle and low segment of the esophagus, 64 cases （ 95.6% ） were endo-luminal growth. The maximum diameter of lesions were ranged from 1 to 6 cm with mean length of （2. 34±1.13） cm. The length of tunnel incision was 1-2 cm with mean length of （ 1.19±0. 37） cm, and the length of submucosal tunnel was 2-7 cm with mean length of （4. 09±1.26） era. The mucosal injury rate and muscularis propria injury rate was 7.5% （5/67） and 4. 5% （3/67）, respectively. The number of hemostatic clips for tunnel incision closure was 2-17 with mean number of 8. 79 ± 3.39. No delayed hemorrhage or severe adverse events occurred in any of the 67 patients following STER. The success rate of STER was 100%. The en bloc resection rate was 91.0% （61/67）, while the en bloc removal rate was 83.6% （56/67）. When the maximum diameter of lesions was more than 3 cm, the operation time increased significantly, while the en bloc resection or removal rates were declined. Conclusion STER is safe and effective for esophageal SMT, especially for lesions located in the middle and low segment esophagus with less than 3 cm maximum diameter.

关 键 词：食管肿瘤 黏膜下肿瘤 内镜经黏膜下隧道肿瘤切除术 

分 类 号：R735.1[医药卫生—肿瘤]