微创医学

目的探讨经内镜黏膜下隧道肿瘤切除术(STER)治疗源于固有肌层的上消化道黏膜下肿瘤(SMTs)的临床疗效及可行性。方法回顾性研究广西医科大学第一附属医院消化内科于2012年11月至2013年11月治疗的12例经CT及超声内镜诊断为来源于固有肌层的上消化道SMTs并接受STER治疗患者的临床资料,总结手术过程,术中、术后以及随访过程中并发症的发生及临床疗效情况。结果 12例患者中,11例病灶位于食管,1例病灶位于贲门。所有患者均能耐受手术,其中11例病灶均由STER一次性完整切除,1例因病灶粘连明显,手术难度大,剥离出血多,耗时长,为保证病人安全仅部分切除肿物。病灶长径0.8~5.0 cm,平均2.2 cm,从黏膜切开至黏膜切口完整缝合时间为45~240 min,平均107 min。术中1例发生皮下及纵隔气肿、气腹,全组病例均无出血、黏膜层破、气胸等并发症。全组均无与手术相关的死亡病例,所有并发症经对症、保守治疗痊愈,无1例追加外科手术。11例患者术后病理及免疫组化均提示为平滑肌瘤,1例术后病理诊断为食管黏膜鳞状上皮中-重度非典型增生。11例患者出院后1~3月内镜复查未见病变残留、复发,1例失访。结论 STER是治疗源于固有肌层的上消化道SMTs的一种微创、可行、安全、有效的方法,可一次性大块切除病变,提供完整的病理学诊断资料,其近期疗效肯定,但远期疗效及远期并发症有待进一步随访。

Objective To evaluate the clinical efficacy and feasibility of submucosal tunneling endoscopic resection ( STEＲ) for upper gastrointestinal ( GI) submucosal tumors ( SMTs) derived from the muscularis propria ( MP) layer． Methods A retrospective study of the clinical data of 12 cases of upper GI-SMTs originating from the MP layer treated by STEＲ after endoscopic ultrasonography ( EUS) and CT examination at Department of Gastroenterology from the First Affiliated Hospital of Guangxi Medical University from Nov． 2012 to Nov． 2013 were carried out． The surgical procedure，intraoperative and postoperative complications during follow-up，and clinical efficacy were sumarrized．Ｒesults Of all the 12 SMTs patients， 11 were located in the esophagus，and 1 in the cardia． All patients could tolerate surgery，among them， 11 lesions were completely resected by STEＲ at one-time，and 1，for the sake of safety，was partially resected due to obvious adhesive lesions，which might lead to sugical difficulty，stripping bleeding，or time-consumption． The average lesion diameter was 2． 2cm ( range 0． 8 － 5． 0cm) ，the average time from mucosal incision to complete mucosal incision suture was 107 min ( range 45 － 240min) ． One case subcutaneous and mediastinalemphysema，and pneumoperitoneum intraoperation occurred． No other complication，like bleeding，mucosal layer break，or pneumothorax，was observed． There was no death related to surgery． All complications were cured by symptomatic and conservative treatment，and there was no need for the resortation for surgerical treatment． Postoperative pathology and immunohistochemistry were suggestive of 11 leiomyoma and 1 esophageal squamous epithelium mucosa of severe atypical hyperplasia． Endoscopic review at 1 to 3 months after discharge in 11 patients showed no residual disease or relapse． One case was not up for follow-up． Conclusion STEＲ is a minimally invasive，safe，efficacious，and feasible new method for the treatment of upper GI-SMTs from the MP layer，since it can resect the lesion in a chunk in a time，provide complete pathological diagnosis，and has a affirmative short-term efficay． Its long-term curative effect and complication remains to be further followed up．