内镜经黏膜下隧道切除术治疗上消化道黏膜下肿瘤的研究

Factors Associated with Successful Submucosal Tunneling Endoscopic Resection Treatment for Upper Gastrointestinal Submucosal Tumors

目的探讨上消化道黏膜下肿瘤(SMTs)的部位、来源层次、大小在内镜经黏膜下隧道切除术(STER)的各个环节如何影响STER的成功率及并发症发生率。方法收集2014年1月1日至2015年6月30日在四川大学华西医院内镜中心行STER治疗的31例上消化道SMTs患者的临床资料并进行分析。结果 31例上消化道SMTs中,29例(93.5%)完成肿瘤切除,失败的2例均为胃部肿瘤。完成切除的29例患者食管与胃黏膜下肿瘤隧道建立时间分别为(13.76±9.70)min、(32.00±27.35)min,P=0.045;黏膜层与固有肌层SMTs的肿瘤切除时间分别为(17.50±9.06)min、(36.24±15.68)min,P=0.004;肿瘤最大径<2.0cm与≥2.0cm的SMTs切除时间分别为(25.78±12.13)min、(39.73±19.23)min,P=0.023。31例STER患者在术中或术后出现并发症共6例(19.4%),均为胃部肿瘤,肿瘤均来源于固有肌层。结论上消化道SMTs的部位、来源层次及肿瘤大小可影响STER的不同手术阶段耗用时间,亦是影响手术成功率及并发症发生率的重要因素。

Objective To determine the influence of location,depth and size of upper gastrointestinal（GI）submucosal tumors（SMTs）on the success of submucosal tunneling endoscopic resection（STER）.MethodsPatient records of 31 cases with upper GI SMTs who had STER between Jan.1,2014 and June 30,2015 in West China Hospital of Sichuan University were retrieved.The success of STER was determined by its efficiency,complete resection rate,and incidence of complications.Results Of the 31 cases,29 were treated successfully,with an average of（13.76±9.70）min and（32.00 ±27.35）min for tunnel formation of esophageal and stomach mucosal tumors respectively（P=0.045）.The 2unsuccessful cases were gastric tumors.SMTs resection for mucous layer and muscularis propria took（17.50±9.06）min and（36.24±15.68）min,respectively（P=0.004）.SMTs resection for tumors diameter〈2.0cm and ≥2.0cm took（25.78±12.13）min and（39.73±19.23）min,respectively（P=0.023）.Six cases of gastric tumors from muscularis propria had complications（19.4%）during or after surgery.Conclusion Location,depth and size of upper GI SMTs has implications on duration of different STER stages,which may determine complete resection rate and incidence of complications.