经黏膜下隧道内镜切除术治疗上消化道固有肌层黏膜下肿瘤的临床疗效

Clinical efficacy of submucosal tunnel endoscopic resection for upper gastrointestinal muscularis propria submucosal tumors

目的 探讨经黏膜下隧道内镜切除术（STER）治疗直径≥3.5cm的上消化道固有肌层黏膜下肿瘤（SMTs）的临床疗效.方法 回顾性分析2011年10月至2014年7月中南大学湘雅二医院收治的14例直径≥3.5 cm的SMTs患者的临床资料,其中13例患者肿瘤位于食管,1例位于贲门.患者均行STER治疗.观察指标：手术时间、肿瘤部位和直径、病理学检查结果、术后并发症发生情况.患者术后定期门诊随访,复查胃镜、EUS、和（或）CT检查.随访时间截至2014年8月.正态分布的计量资料采用均数（范围）表示.结果 14例患者均成功完成手术,平均手术时间为83 min（60 - 160 min）.共取出14枚肿瘤;其中13枚位于食管,1枚肿瘤位于贲门.13枚肿瘤整块切除后从隧道内取出,1枚肿瘤因较大（直径为5.3 cm）,且紧邻气管,予分为两块切除后取出.14枚肿瘤平均直径为4.1 cm.术后病理学诊断均为平滑肌瘤.3例患者术后发生并发症,其中颈部皮下气肿1例,胸骨后疼痛1例,隧道黏膜撕裂1例,放置金属支架2周后,黏膜愈合良好.患者术后平均住院时间为6.4 d（4.0-8.0 d）.所有患者获得随访,中位随访时间为11.5个月（1.0 -24.0个月）,无一例复发.结论 STER治疗直径≥3.5cm的SMTs安全有效.

Objective To evaluate the clinical efficacy of submucosal tunnel endoscopic resection （STER） for upper gastrointestinal muscularis propria submucosal tumors （SMTs） with diameter ≥3.5 cm.Methods The clinical data of 14 patients with SMTs≥3.5 cm who were admitted to the Second Xiangya Hospital of Central South University between October 2011 and July 2014 were retrospectively analyzed, including 13 patients with tumor at esophagus and 1 patient with tumor at cardia.All patients underwent STER and the observed indexes included operation tine, tumor location and diameter, results of pathological examination and occurrence of postoperative complications.All patients were followed up regularly at the out-patient department including reexamination of gastroscopy, endoscopic ultrasonography （EUS） and computed tomography （CT） till August 2014.Measurement data with normal distribution were presented as average （range）.Results All the 14 patients underwent STER successfully with mean operation time of 83 minutes （range, 60-160 minutes）.Fourteen tumors were exited, with 13 located at esophagus and 1 at gastric cardia.En bloc resection was achieved in 13 patients and the tumors were extracted through the tunnel.The tumor in the remaining 1 patient was large with a diameter of 5.3 cm and close to trachea, it was extracted by 2 pieces.The average diameter of 14 tumors extracted was 4.1 cm and postoperative pathological examination confirmed the tumors as leiomyomas.Three patients had postoperative complications, subcutaneous emphysema occurred in 1 patient and retrosternal pain in 1 patient.One patient suffered mucosal laceration and recovered after a metal stent was inserted for 2 weeks.The average duration of postoperative hospital stay was 6.4 days （range, 4.0-8.0 days）.All patients were followed up for a median time of 11.5 months （range, 1.0-24.0 months） with no recurrence.Conclusion STER is a safe and effective method for SMTs with diameter≥3.5 cm.