内镜经黏膜下隧道肿瘤切除术治疗食管及贲门固有肌层来源大型症状性黏膜下肿瘤的可行性和安全性分析  

Feasibility and safety of submucosal tunneling endoscopic resection for the treatment of giant symptomatic submucosal tumors originating from the muscularis propria layer of the esophagus and cardia

作　　者：林佳佳 王珏 姜琦[3] 胡皓 周平红 LIN Jiajia;WANG Jue;JIANG Qi;HU Hao;ZHOU Pinghong(Endoscopy Center,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Shanghai Geriatric Medical Center(Zhongshan Hospital Minhang Meilong Branch),Shanghai 201104,China;Endoscopy Center,Zhongshan Hospital(Xiamen Branch),Fudan University,Xiamen 361015,Fujian,China)

机构地区：[1]复旦大学附属中山医院内镜中心,上海200032 [2]上海市老年医学中心(复旦大学附属中山医院闵行梅陇院区),上海201104 [3]复旦大学附属中山医院厦门医院内镜中心,厦门361015

出　　处：《中国临床医学》2024年第4期586-592,共7页Chinese Journal of Clinical Medicine

基　　金：国家自然科学基金青年项目(81701750);上海市2022年度“科技创新行动计划”医学创新研究专项(22Y11907500)。

摘　　要：目的探讨内镜经黏膜下隧道肿瘤切除术(submucosal tunneling endoscopic resection,STER)治疗食管和贲门固有肌层来源的大型(长径≥3.5 cm)症状性黏膜下肿瘤(submucosal tumor,SMT)的可行性及安全性。方法回顾性分析2017年1月至2020年1月复旦大学附属中山医院内镜中心收治的接受STER治疗的食管和贲门大型症状性SMT患者的临床特征和随访资料。采用完全切除率、复发率和残留率评估STER的疗效,分析手术相关并发症发生情况以评价STER的安全性。结果共纳入111例SMT患者,其中男性65例、女性46例,平均年龄(43.2±11.6)岁,11例(9.9%)患者有典型症状。切除肿瘤中,平滑肌瘤105例、胃肠道间质瘤2例、神经鞘瘤4例,瘤体中位长径5 cm、中位短径3 cm,中位手术时间70 min,中位住院时间3 d。STER手术成功率100%,肿瘤完全切除率73.9%。术中黏膜破损18例(16.2%);发生术后并发症16例(14.4%),其中严重气胸/胸腔积液(需要引流)10例(9.0%),迟发性出血1例(0.9%),中度以上发热4例(3.6%),隧道内感染1例(0.9%)。随访1~18个月,未发现肿瘤残留、复发,无食管狭窄及憩室等远期并发症。结论STER治疗食管和贲门大型症状性SMT安全有效。Objective To explore the feasibility and safety of submucosal tunneling endoscopic resection(STER) for the treatment of giant(long diameter≥3.5 cm) symptomatic submucosal tumors(SMT) originating from the esophageal and cardiac muscularis propria layer. Methods A retrospective analysis was conducted on patients with giant symptomatic SMT of the esophagus and cardia treated with STER at the Endoscopy Center of Zhongshan Hospital, Fudan University from January 2017 to January 2020. Clinical characteristics and follow-up data of patients were collected. The efficacy of STER was evaluated by complete resection rate, recurrence rate, and residual rate. The safety of the procedure was assessed by the occurrence of procedurerelated complications. Results A total of 111 patients with SMT were included, including 65 males and 46 females, with an average age of(43.2±11.6) years old. Among them, 11 patients(9.9%) presented with typical symptoms. Leiomyomas accounted for 105 cases, gastrointestinal stromal tumors for 2 cases, and schwannoma for 4 cases. The median long diameter of the tumors was5 cm, and the median short diameter was 3 cm. The median operation time was 70 minutes, and the median time of hospital stay was3 days. The success rate of STER was 100%, with a complete resection rate of 73.9%. Intraoperative mucosal injury was observed in 18 cases(16.2%), postoperative complications occurred in 16 cases(14.4%), including severe pneumothorax/pleural effusion requiring drainage in 10 cases(9.0%), delayed bleeding in 1 case(0.9%), moderate or severe fever in 4 cases(3.6%), and infection in tunnel in 1 case(0.9%). Follow-up at 1-18 months showed no tumor residue, recurrence, esophageal stenosis, diverticula or other long-term complications. Conclusions STER is a safe and effective treatment for giant symptomatic SMT of the esophagus and cardia.

关 键 词：内镜经黏膜下隧道肿瘤切除术 黏膜下肿瘤 食管 贲门 并发症 

分 类 号：R57[医药卫生—消化系统]