内镜经黏膜下隧道肿瘤切除术治疗巨大食管固有肌层肿瘤的探讨

Therapeutic effects of submucosal tunneling endoscopic resection on large esophageal submucosal tumors originating from muscularis propria layer

目的评价内镜经黏膜下隧道肿瘤切除术（STER）治疗巨大食管固有肌层肿瘤的临床价值。方法2009年12月至2016年3月，天津医科大学总医院消化内镜中心接受STER治疗（STER组，n=17）或内镜黏膜下剥离术（ESD）治疗（ESD组，n=15）的巨大食管固有肌层肿瘤（病变最长径≥3．5cm）病例纳入回顾性分析，比较2组治疗效果、术后住院时间和费用、并发症发生情况等。结果32例患者的内镜治疗均顺利完成，平均手术时间STER组明显长于ESD组（t=2．595，P=0．015），整块切除率、完全切除率及并发症发生率STER组与ESD组差异均无统计学意义（P〉0．05）。术后平均住院时间STER组明显短于ESD组[（3．8±1．0）d比（6．7±1．8）d，t=5．644，P=0．000]，平均住院费用STER组明显少于ESD组[（22456．1±5232．0）元比（27392．5±5747．9）元，t=2．543，P=0．016]。术后1个月创面完全愈合率STER组明显高于ESD组[94．1％（16／17）比20．0％（3／15），P=0．000]，平均随访（41．2±20．6）个月2组均无复发和远处转移。结论STER治疗巨大食管固有肌层肿瘤安全、有效，较之ESD具有术后住院时间短、住院费用少、创面愈合快等优点，可能更适合于巨大食管固有肌层肿瘤的治疗。

Objective To estimate the safety and efficacy of submucosal tunneling endoscopic resection （STER） on treatment of large esophageal submucosal tumors （SMTs） originating from muscularis propria layer. Methods The data of patients with large esophageal SMTs （ diameter≥ 3.5 cm） undergone STER （n= 17） or endoscopic submucosal dissection （ESD, n = 15） at the Endoscopy Center of Tianjin Medical University General Hospital from December 2009 to March 2016 were retrospective analyzed. The therapeutic effects, hospitalization times, post-operation expenses, and occurrence of complications were evaluated and compared between the two groups. Results All the endoscopic treatments of the 32 patients were successfully completed. The operating time of the STER group was significantly longer than that of the ESD group （t = 2. 595, P = 0. 015）. There was no statistical difference on the en bloc resection rate, complete resection rate and complication rate between STER group and ESD group （P〉0.05）. The mean post-operative hospital stay of the STER group was significantly less than that of the ESD group （3.8± 1.0 days VS 6. 7±1.8 days, t=5. 644, P=0. 000）. The mean hospital cost of the STER group was significantly less than that of the ESD group （ 22 456. 1 ± 5 232. 0 yuan VS 27 392. 5± 5 747.9 yuan, t = 2. 543, P = 0. 016）. The wound healing rates at 1 month after operation in the STER group was significantly higher than that of the ESD group [ 94. 1% （16/17） VS 20.0% （ 3/15 ）, P = 0. 000 ]. No recurrence and metastasis occurred in the STER group and ESD group during the 41.2-＋20. 6 months follow-up. Conclusion STER is a safe and effective technique for treating large esophageal SMTs originating from the muscularis propria layer, with earlier wound healing, shorter hospital stay and lower cost compared with those of the traditional method of ESD.