ESD与STER治疗食管平滑肌瘤的临床应用及效果分析  

Clinical application and efficacy analysis of ESD and STER in the treatment of esophageal leiomyoma

作　　者：次仁玉珍 余晓云[2] 沈磊[1] Cirenyuzhen;YU Xiaoyun;SHEN Lei(Department of Gastroenterology,Renmin Hospital of Wuhan University,Wuhan 430060;Department of Gastroenterology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,China)

机构地区：[1]武汉大学人民医院消化内科,湖北武汉430060 [2]华中科技大学同济医学院附属协和医院消化内科

出　　处：《胃肠病学和肝病学杂志》2024年第11期1425-1429,共5页Chinese Journal of Gastroenterology and Hepatology

基　　金：国家自然科学基金(82070555)。

摘　　要：目的探讨内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)和经内镜黏膜下隧道肿瘤切除术(submucosal tunneling endoscopic resection,STER)在食管平滑肌瘤治疗中的价值。方法回顾性分析2016年1月至2022年6月于武汉大学人民医院消化内科进行ESD与STER治疗、术后病理及免疫组化确诊为食管平滑肌瘤的181例患者的临床资料。结果181例患者的食管平滑肌瘤在内镜下被成功切除,病灶多呈表面光滑隆起形态(175/181,96.7%),色泽多正常,多位于食管下段处(84/181,46.4%)。ESD组135例,其中125例(92.6%)行EUS检查,结果显示,91例(72.8%)病灶起源于黏膜肌层,15例(12.0%)起源于黏膜下层,15例(12.0%)起源于固有肌层,4例(3.2%)起源于黏膜多层,大部分为均匀低回声灶,有5例内部回声欠均匀。STER组46例,其中45例(97.8%)行EUS检查,10例(22.2%)病灶起源于黏膜肌层,1例(2.2%)起源于黏膜下层,31例(68.9%)起源于固有肌层,3例(6.7%)起源于黏膜多层,大部分呈均匀低回声灶,仅有2例内部回声欠均匀。在病灶位置上,ESD组中食管上段45例,食管中段40例,食管下段50例,STER组中食管上段4例,食管中段8例,食管下段34例。在病灶大小上,ESD组中病灶<2 cm有127例、≥2 cm有8例,STER组中34例<2 cm、12例≥2 cm;两组在病灶起源、位置、大小方面比较,差异有显著统计学意义(P<0.001)。行内镜下治疗时,STER组手术时间较ESD组时间长,且其在住院天数、治疗费用、术后发生并发症方面也比ESD手术组多,差异均有统计学意义(P<0.05)。随访出院后门诊行胃镜检查发现,181例患者中有64例(35.4%)完成术后1~24个月内随访,其中有8例(12.5%)发现食管肿物残留或复发。结论食管平滑肌瘤多位于食管下段且病灶常<2 cm,以黏膜肌层来源常见。ESD治疗黏膜肌层来源、STER治疗固有肌层来源的食管平滑肌瘤均较为安全有效,STER治疗技术仍需进一步优化从而减少并发症的发生。Objective To investigate the value of endoscopic submucosal dissection(ESD)and submucosal tunneling endoscopic resection(STER)in the treatment of esophageal smooth muscle tumors.Methods The clinical data of 181 patients who underwent ESD and STER in the Department of Gastroenterology,Renmin Hospital of Wuhan University from Jan.2016 to Jun.2022,and whose diagnosis of esophageal smooth muscle tumor was confirmed by postoperative pathology and immunohistochemistry were retrospectively analyzed.Results A total of 181 cases of esophageal smooth muscle tumors were successfully resected endoscopically,and most of the lesions showed a smooth surface elevation pattern(175/181,96.7%)with normal color,mostly located at the lower esophagus(84/181,46.4%).One hundred and thirty-five cases in the ESD group,of which 125 patients(92.6%)underwent EUS,91 lesions(72.8%)originated in the muscularis mucosae,15 lesions(12.0%)originated in the submucosa,15 lesions(12.0%)originated in the muscularis propria,and 4 lesions(3.2%)originated in multiple layers of the mucosa,most of which were homogeneous hypoechoic foci,with 5 cases having inhomogeneous internal echoes.In the STER group of 46 cases,of which up to 45 patients(97.8%)underwent EUS,10 lesions(22.2%)originated in the muscularis mucosae,1 lesion(2.2%)originated in the submucosa,31 lesions(68.9%)originated in the muscularis propria,and 3 lesions(6.7%)originated in the multiple layers of the mucosa,most of which were homogeneous hypoechoic foci,and only 2 cases had inhomogeneous internal echoes.In terms of lesion location,there were 45 cases in the upper esophagus,40 cases in the middle esophagus,50 cases in the lower esophagus in the ESD group,and 4 cases in the upper esophagus,8 cases in the middle esophagus,34 cases in the lower esophagus in the STER group.In terms of lesion size,there were 127 cases of lesions<2 cm and 8 cases of≥2 cm in the ESD group and 34 cases of<2 cm and 12 cases of≥2 cm in the STER group.The differences in lesion origin,location and size between the tw

关 键 词：食管平滑肌瘤 内镜黏膜下剥离术 经内镜黏膜下隧道肿瘤切除术 

分 类 号：R735.1[医药卫生—肿瘤]