保留黏膜层的内镜黏膜下挖除术治疗胃黏膜下肿瘤的有效性分析  

Efficacy analysis of endoscopic submucosal excavation with mucosal layer preservation for gastric submucosal tumors

作　　者：葛佳琪 孙晓梅[1] Ge Jiaqi;Sun Xiaomei(Department of Gastroenterology,Digestive Disease Hospital,Heilongjiang Provincial Hospital,Harbin150001,China)

机构地区：[1]黑龙江省医院消化病院消化内科,哈尔滨150001

出　　处：《中华消化内镜杂志》2024年第12期961-966,共6页Chinese Journal of Digestive Endoscopy

摘　　要：目的:比较保留黏膜层的内镜黏膜下挖除术(endoscopic submucosal excavation,ESE)与传统ESE治疗起源于固有肌层、长径≤2 cm的胃黏膜下肿瘤(submucosal tumors,SMT)的有效性及安全性。方法:回顾性分析2021年11月至2022年11月于黑龙江省医院消化病院接受保留黏膜层的ESE(保留黏膜组,30例)或传统ESE(不保留黏膜组,30例)治疗的长径≤2 cm起源于固有肌层的胃SMT患者资料。比较两组患者的一般资料(性别、年龄、肿瘤发生部位及大小),分析内镜相关治疗结果,包括整块切除率、手术时间、术中出血量、术中穿孔率及术后并发症(出血、穿孔、感染)发生率、经济效益、术后住院时间等指标。结果:两组患者的一般资料差异无统计学意义(P>0.05)。保留黏膜组与不保留黏膜组的整块切除率[100.0%(30/30)比90.0%(27/30),P=0.237]、术中出血量[(23.34±14.68)mL比(23.67±14.73)mL,t=0.085,P=0.932]、术中穿孔率[0.0%(0/30)比16.7%(5/30),P=0.052]及术后住院时间[(5.17±1.46)d比(5.93±1.59)d,t=1.939,P=0.057]差异均无统计学意义。两组患者均无术后出血、穿孔、发热和腹膜炎发生。但保留黏膜组手术时间低于不保留黏膜组,分别为(47.07±14.03)min及(59.47±16.75)min(t=3.107,P=0.003);保留黏膜组住院费用显著低于不保留黏膜组,分别为(22109.68±3960.65)元及(28378.64±3842.31)元(t=6.222,P=0.001)。结论:保留黏膜层的ESE与传统ESE治疗起源于固有肌层的长径≤2 cm的胃SMT安全有效。与传统ESE相比,保留黏膜层的ESE手术时间较短、医疗费用更低。ObjectiveTo compare the efficacy and safety of endoscopic submucosal excavation(ESE)with mucosal layer preservation and traditional ESE for patients with small(≤2 cm)gastric submucosal tumors(SMT)originating from muscularis propria.MethodsA retrospective study was performed on patients with gastric SMT(≤2 cm)originating from muscularis propria treated by ESE with mucosal layer preservation(mucosal layer preservation group,30 cases)or traditional ESE(non-mucosal layer preservation group,30 cases)in Digestive Disease Hospital,Heilongjiang Provincial Hospital from November 2021 to November 2022.Baseline characteristics(gender,age,tumor location and size)and endoscopy-related treatment outcomes including en bloc resection rate,operation time,intraoperative blood loss,intraoperative perforation rate and postoperative complications(bleeding,perforation,infection)rate,economic benefits,and postoperative hospitalization time were compared.ResultsThere was no significant difference in the baseline characteristics between the two groups(P>0.05).As for en bloc resection rate[100.0%(30/30)VS 90.0%(27/30),P=0.237],intraoperative blood loss(23.34±14.68 mL VS 23.67±14.73 mL,t=0.085,P=0.932),intraoperative perforation rate[0.0%(0/30)VS 16.7%(5/30),P=0.052],and hospitalization time(5.17±1.46 days VS 5.93±1.59 days,t=1.939,P=0.057),there were no significant differences between the mucosal layer preservation group and the non-mucosal layer preservation group.No postoperative bleeding,perforation,fever or peritonitis occurred in either group.However,the operation time was shorter in the mucosal layer preservation group than that in the non-mucosal layer preservation group(47.07±14.03 min VS 59.47±16.75 min,t=3.107,P=0.003).The hospitalization expenses in the mucosal layer preservation group were significantly lower than those in the non-mucosal layer preservation group(22109.68±3960.65 yuan VS 28378.64±3842.31 yuan,t=6.222,P=0.001).ConclusionBoth ESE with mucosal layer preservation and traditional ESE are safe and reliab

关 键 词：胃肿瘤 黏膜下肿瘤 内镜黏膜下挖除术 内镜治疗 保留黏膜层 

分 类 号：R73[医药卫生—肿瘤]