内镜经黏膜下隧道肿瘤切除术和胸腔镜下切除术治疗食管固有肌层肿瘤的疗效比较  

Efficacy comparison between submucosal tunneling endoscopic resection and thoracoscopic enucleation for esophageal submucosal tumors originating from the muscularis propria layer

作　　者：贺德志[1] 岳来福 王小彤 刘冰熔[1] 李建生[1] 韩艳妙 徐海莉[1] 宋李娟 赵梦月 魏珂乐 HE Dezhi;YUE Laifu;WANG Xiaotong;LIU Bingrong;LI Jiansheng;HAN Yanmiao;XU Haili;SONG Lijuan;ZHAO Mengyue;WEI Kele(Department of Gastroenterology,the First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052)

机构地区：[1]郑州大学第一附属医院消化内科,郑州450052

出　　处：《郑州大学学报（医学版）》2021年第5期685-689,共5页Journal of Zhengzhou University(Medical Sciences)

基　　金：河南省科技创新杰出人才项目(184200510020)。

摘　　要：目的:探讨内镜经黏膜下隧道肿瘤切除术(STER)和胸腔镜下切除术在直径2.0~5.0 cm食管固有肌层肿瘤治疗中的临床价值。方法:对2016年6月至2020年6月在郑州大学第一附属医院行STER(n=57,STER组)或胸腔镜下切除(n=40,胸腔镜组)的97例食管固有肌层肿瘤病例资料进行回顾性研究,对比分析两组手术成功切除率和肿瘤完全切除率、手术时间、并发症、术后住院时间以及复发情况。结果:两种术式肿瘤成功切除率均为100%。对于直径2.0~3.5 cm瘤体,两组完全切除率相近[82.9%(34/41)vs 86.4%(19/22),P>0.999],但STER组平均手术时间、术后住院时间短于胸腔镜组[(55.37±15.91)min vs(90.64±28.21)min,6.0(5.0,7.0)d vs 7.0(5.8,10.0)d,P均<0.05]。对于直径>3.5~5.0 cm瘤体,胸腔镜组完全切除率高于STER组[83.3%(15/18)vs 43.8%(7/16),P=0.030];胸腔镜组术后发热发生率高于STER组[61.1%(11/18)vs 18.8%(3/16),P=0.017]。不论肿瘤大小,STER组住院费用、术后胸痛和胸腔积液发生率均低于胸腔镜组。随访1~36个月,两组均无肿瘤残留及复发。结论:对于直径2.0~3.5 cm肿瘤,STER更加安全和高效;对于直径>3.5~5.0 cm肿瘤,胸腔镜手术在完全切除方面优势突出。Aim:To evaluate the clinical value of submucosal tunneling endoscopic resection and thoracoscopic enucleation for diameter 2.0-5.0 cm esophageal submucosal tumors originating from the muscularis propria layer.Methods:Data of 97 patients with diameter 2.0-5.0 cm esophageal submucosal tumors originating from the muscularis propria layer who underwent submucosal tunneling endoscopic resection(n=57,STER group)or thoracoscopic enucleation(n=40,thoracoscopic enucleation group)at the First Affiliated Hospital of Zhengzhou University from June 2016 to June 2020 were retrospectively studied.The success rate of tumor resection,tumor complete resection rate,operation time,complications,postoperative hospital stay and recurrence of the two groups were compared and analyzed.Results:The success rate of tumor resection of both methods was 100%.For diameter 2.0-3.5 cm tumors,the complete resection rates of the two groups were similar[82.9%(34/41)vs 86.4%(19/22),P>0.999],but the average operation time and postoperative hospital stay in the STER group were significantly shorter than those in the thoracoscopic enucleation group[(55.37±15.91)min vs(90.64±28.21)min,6.0(5.0,7.0)days vs 7.0(5.8,10.0)days,P<0.05].For diameter>3.5-5.0 cm tumors,the rate of complete resection of the thoracoscopic enucleation group was significantly higher than that of the STER group[83.3%(15/18)vs 43.8%(7/16),P=0.030].The incidence of postoperative fever in the thoracoscopic enucleation group was higher than that in the STER group[61.1%(11/18)vs 18.8%(3/16),P=0.017].Regardless of the size of the tumor,the cost of hospitalization,and the incidence of postoperative chest pain and pleural effusion in the STER group were significantly lower than those in the thoracoscopic enucleation group.Follow-up for 1-36 months,there was no residual tumor or recurrence in both groups.Conclusion:For diameter 2.0-3.5 cm tumors,STER is safer and more efficient,while for diameter>3.5-5.0 cm tumors,thoracoscopic enucleation has outstanding advantages in complete resection.

关 键 词：食管黏膜下肿瘤 固有肌层 内镜经黏膜下隧道肿瘤切除术 胸腔镜下切除术 

分 类 号：R735.1[医药卫生—肿瘤]