内镜经黏膜下隧道肿瘤切除术治疗直肠固有肌层肿瘤

Submucosal tunneling endoscopic resection in the treatment of rectal submucosal tumorsoriginating from muscularis propria

目的评价内镜经黏膜下隧道肿瘤切除术（STER）治疗来源于固有肌层的直肠黏膜下肿瘤（SMT）的临床效果。方法回顾性分析2011年3月至2013年3月间在复旦大学附属中山医院内镜中心行STER术治疗的8例来源于固有肌层的直肠黏膜下肿瘤的临床病理资料。结果8例STER手术均获成功，肿瘤均一次性完整切除，肿块距肛缘5～15cm，切除标本最大直径1．0～3．5（平均1．8）cm，手术耗时40～70（平均51）min。术中黏膜穿孔1例，予以金属夹夹闭修补成功。术后出现下肢皮下气肿1例，对症支持治疗2周后完全消退。术后病理诊断：神经鞘瘤3例，平滑肌瘤2例，胃肠间质瘤1例，增生胶原纤维伴结节变性2例。术后随访6～30月未见病变残留或复发。结论采用STER技术切除直肠固有肌层来源的SMT是一种安全、可行、有效的治疗方法。

Objective To evaluate the clinical value of submucosal tunneling endoscopic resection （STER） for rectal submucosal tumors （SMT） originating from muscularis propria. Methods Clinicopathological data of 8 cases with rectal SMT originating from muscularis pmpria undergoing STER in our center from March 2011 to March 2013 were analyzed retrospectively. Results En bloc STER was performed successfully in all the 8 cases. The tumors location was 5-15 cm from the edge of anus. The resected specimen size ranged from 1.0 to 3.5 cm （average 1.8 cm）. The mean procedure time was 51 rain（range, 40-70 rain）. One patient developed mucosa perforation and was repaired with metal clips. One patient developed subcutaneous emphysema in one leg, which was disappeared after two weeks. Postoperative pathological examination revealed schwannoma in 3 cases, leiomyoma in 2 cases, stromal tumor in l case, and proliferation of collagen fibers nodular degeneration in 2 cases. Postoperative follow-up ranged from 6 to 30 months and no residual lesion or recurrence was found. Conclusion STER is a safe and effective method for rectal SMT originating from muscularis propria in our initial experience.