经黏膜下隧道内镜切除术治疗食管中下段黏膜下肿瘤的初步探索

Preliminary exploration on submucosal tunneling endoscopic resection for middle and lower esophagus submueosal tumors

目的探讨经黏膜下隧道内镜切除术（STER）治疗来源于食管中下段黏膜下肿瘤（SMT）的效果和安全性。方法回顾性总结2012年3月至2013年3月南京医科大学第一附属医院消化内镜中心收治的33例经胃镜和超声胃镜、CT诊断为食管黏膜下肿瘤患者的临床资料，均行STER切除。其中男17例，女16例，平均年龄（504-10）岁。分析病变起源、大小、病理、手术时间、术后并发症。结果33例食管中下段SMT来源于黏膜下层4例（12．1％），固有肌层浅层18例（54．6％），固有肌层深层10例（30．3％），纤维膜层1例（3．0％）；单个瘤体30例（90．9％），2个瘤体2例（6．1％），3个瘤体1例（3．0％）。33例中血管瘤1例未切除无标本，余术后瘤体共36个，病理诊断平滑肌瘤30个（83．3％），间质瘤5个（13．9％），脂肪瘤1个（2．8％）；STER完整切除32例（97．0％），1例血管瘤未予切除。切除病变直径平均（1．7±1．0）cm，手术时间平均（49±26）min；完整缝合创面所用金属夹平均（7．8±2．5）枚。皮下气肿3例（9．1％），穿孔、气胸1例（3．O％），均保守治疗后好转。结论STER治疗食管中下段SMT安全、有效，可以一次性完整切除病变，提供完整的病理学诊断资料，可以避免消化道漏和胸腹腔继发感染。

Objective To evaluate the efficacy and safety of submucosal tunneling endoscopic resection （STER） in the treatment of middle and lower esophagus submucosal tumors （SMT） originating from muscularis propria （MP） layer. Methods A total number of 33 esophagus submucosal tumor （SMT） originating from MP layer underwent tumor resection by STER after endoscopic ultrasonography （EUS） and CT examination at Endoscopy Center, Department of Gastroenterology, First Affiliated Hospital, Nanjing Medical University from March 2012 to March 2013. There were 17 males and 16 females with an age range of （50 ± 10） years. Their lesion size, lesion origin, pathology, operative duration and complication rate were analyzed. Results Among them, the origins were of submucosal （n = 4, 12. 1% ）, superficial muscularis propria layer （SMP） （n = 18, 54. 6% ）, deep muscularis layer （DMP） （n = 10, 30. 3% ） and serosa （n = 1, 3.0% ）. There were single tumor （n = 30, 90.9% ）, double tumors （n = 2, 6. 1% ） and triple tumors （ u = 1, 3.0% ）. Except for 1 case of non-resected hemangioma, 36 operative specimens were examined pathologically, including 30 leiomyomas tumors （83.3%）, 5 stromal tumors （GIST） （ 13.9% ） and 1 lipoma tumor （2. 8% ）. Thirty-two lesions were successfully reseeted by STER with a complete resection rate of 97.0%. Average lesion size was （ 1.7 ± 1.0） cm and average operative duration （49 ＋ 26） min. A number of （7.8 ± 2. 5 ） hemostatic clips were used to close the mucosal incision site. Subcutaneous emphysema occurred in 3 patients （9. 1% ） while puncture and pneumothorax developed in one ease（3.0%）. All of them recovered uneventfully through conservative treatments. Conclusions As a new safe, efficacious and feasible treatment for middle and lower esophagus submucosal tumors, STER may completely resect SMT and provide accurate histopathological evaluations. And it is feasible to regain the mucosal integrity of GI tract and prevent the occurrences of leakage and secondary infections.