内镜黏膜下挖除术治疗消化道黏膜下肿瘤108例分析

Analysis of 108 cases of submucosal tumor treated by endoscopic submucosal excavation

目的探讨内镜黏膜下挖除术治疗消化道黏膜下肿瘤的疗效和安全性。方法选择2010年至2013年经内镜、超声内镜及增强CT检查发现。以向腔内生长为主的消化道黏膜下肿瘤108例进行内镜黏膜下挖除术。完整挖除病变后送病理检查，术后1、3、6、12、24个月内镜随访。结果108例病变中位于食管27例，责门8例，胃部59例，十二指肠2例，直肠12例。最大径为0．5～5．5cm，平均为2．1cm，操作时间为18～240rain，平均为105min。3例胃部黏膜下肿瘤分别因肿瘤向腔外生长、与肌层紧密粘连无法分离、穿孔大无法修补而转腹腔镜手术；3例胃底黏膜下肿瘤操作失败而放弃，其余102例病变（94．44％）一次性完整切除。术中穿孔19例（17．59％），其中1例行转腹腔镜手术，18例在内镜下有效缝合。术中出血0～50mL不等，无术后出血。术后发生颈部皮下气肿8例，气腹9例，左侧腮腺肿胀1例。9例失访，其余99例随访1～24个月，无一例复发。结论内镜黏膜下挖除术能一次性完整挖除较大的，以向腔内生长为主的黏膜下肿瘤，可提供完整的病理诊断资料且安全、有效。

Objective To evaluate the efficacy and safety of endoscopic submucosal excavation in the treatment of submucosal tumor. Methods From 2010 to 2013, a total of 108 cases of submucosal tumor detected by endoscopic, endoscopic uhrasonography and computed tomography （CT） scan, most of which grew toward the lumen, were treated by endoscopic submucosal excavation. After the lesions were completely excavated, pathological examination were performed. All the cases were followed up with endoscopic examination at one, three, six, 12 and 24 months after operation. Results Among 108 cases of lesions, 27 cases were located in esophagus, eight in cardia, 59 in stomach, two in duodenum and 12 cases in rectum. The diameters of the lesions ranged from 0.5 to 5.5 em （median 2.1 cm）. Operation time was between 18 and 240 minutes （median 105 minutes）. The endoscopic treatment was converted to laparoseopic operation in three cases because the submucosal tumors of gastric body growing towards outside the lumen, or adhesive to muscular layer tightly and or perforation too big to be sutured. Three cases of submucosal tumor of fundus were failed to excavate, the other 102 cases （94.44~） of lesions were completely removed. Perforation occurred in 19 cases （17.59%）. The procedure was converted to laparoscopic operation in one case. Effective endoscopic suture was complered in 18 cases. The volume of haemorrhage during operation was about 0 to 50 mL and no post-operational bleeding was found. Eight cases had cervical subcutaneous emphysema. Nine cases had pneumoperitoneum. Left parotid gland swollen was found in one case. Nine cases were lost to follow up. The left 99 cases were followed up for one to 24 months and no recurrence. Conclusion ndoscopic submucosal excavation safety and effectively achieve once complete removed of the big suhmucosal tumor which grows towards inside the lumen, and provide complete pathologic data.