经内镜行隧道式黏膜剥离术治疗食管大面积浅表性肿瘤的疗效和安全性

Effect and safety of endoscopic submucosal tunnel dissection in the treatment of large esophageal superficial neoplasms

目的 :探讨经内镜行隧道式黏膜剥离术治疗食管大面积浅表性肿瘤的疗效和安全性。方法 :回顾性分析2013年1月—2015年12月我院收治的48例食管大面积浅表性肿瘤患者的临床资料,根据手术方式的不同分为对照组23例和研究组25例。对照组给予常规内镜下黏膜剥离术(ESD)治疗,研究组给予内镜下隧道式黏膜剥离术(ESTD)治疗。比较两组患者的手术相关指标、术中并发症发生情况、术后1年肿瘤复发情况。检测并比较两组患者手术前和手术后3 d、7 d血清IL-8、TNF-a和hs-CRP的水平。结果 :研究组的剥离速度、术中出血量和根治性切除率显著优于对照组(P<0.05)。研究组治疗后食管出血和食管狭窄的发生率分别为4.00%和12.00%,显著低于对照组的30.44%和39.13%(P<0.05)。研究组患者治疗后3 d、7 d血清IL-8、TNF-a和hs-CRP的水平显著低于对照组(P<0.05)。研究组患者手术1年后肿瘤的复发率为0.00%,显著低于对照组的21.73%(P<0.05)。结论 :ESTD治疗食管大面积浅表性肿瘤能有效提高肿瘤的剥离速度和根治性切除率,降低并发症的发生率,改善患者的预后,且还能缓解炎症和应激反应,对机体的创伤小,值得应用于临床。

Objective： To discuss the effect and safety of endoscopic submucosal tunnel dissection（ESTD） and endoscopic submucosal dissection（ESD） in the treatment of large esophageal superficial neoplasms. Methods： The data from 48 patients with large esophageal superficial neoplasms were retrospectively analyzed. The patients were divided into a control group（undergoing ESD） with 23 cases and a research group（undergoing ESTD） with 25 cases based on their different methods for surgery. The surgery-related index, complications and local neoplasm recurrence were compared between two groups. The serum levels of IL-8, TNF-a and hs-CRP were detected and compared before treatments and 3 and 7 days after. Results： Tumor stripping rate, bleeding during surgery and radical curative rate were much better in the research group than in the control group（P〈0.05）. The incidence of esophageal bleeding and esophageal stenosis after treatment was 4.00% and 12.00% in the research group and 30.44% and 39.13% in the control group, which was notably lower in the research group（P〈0.05）. The serum levels of IL-8, TNF-a and hs-CRP on the 3rd and 7th days after treatment were significantly lower in the research group than in the control group（P〈0.05）. The tumor recurrence found in one year after surgery was 0.00% in the research group and 21.73% in the control group. Conclusion： ESTD for the treatment of patients with large esophageal superficial neoplasms can not only enhance the tumor stripping rate and radical curative rate and decrease the incidence of complications and improve the prognosis, but also can alleviate inflammation and stress reaction with less trauma on the body, which is worthy of clinical use.