内镜下微创手术治疗食管下段黏膜下肿物的疗效分析

Endoscopic Minimally Invasive Surgery for the Treatment of Submucosal Masses under the Esophagus

目的探讨内镜黏膜下剥离术(ESD)和经内镜黏膜下隧道肿瘤切除术(STER)治疗食管下段黏膜下肿物(SMT)的疗效。方法方便选取郑州大学第二附属医院消化内镜中心2013年6月—2018年6月53例经过胃镜和超声内镜检查符合条件的患者,STER组28例,ESD组25例,对比分析两组患者瘤体直径、手术时间、住院时间及术中术后并发症情况。结果 STER组手术时间、住院天数与ESD组相比,差异无统计学意义(t=1.51、0.19,P>0.05),但瘤体直径明显大于ESD组[(1.61±0.99)cm vs(0.94±0.48)cm],差异有统计学意义(t=3.186,P<0.05);ESD组与STER组瘤体完整切除率分别为100%、92.85%,两组出血、穿孔、皮下气肿的发生率比较差异无统计学意义(P>0.05),但是STER组术后低热发生率明显低于ESD组,为3.57%(1/28) vs 28.00%(7/28),差异有统计学意义(χ~2=4.39,P<0.05)。结论内镜下微创手术治疗食管下段肿物安全有效,术后恢复快,瘤体较大者,考虑术后感染者,STER术具有优势。

Objective To investigate the efficacy of endoscopic submucosal dissection(ESD) and endoscopic submucosal tumor resection(STER) in the treatment of submucosal masses(SMT). Methods From June 2013 to June 2018, the Department of Digestive Endoscopy of the Second Affiliated Hospital of Zhengzhou University convenient selected 53 patients who underwent endoscopy and endoscopic ultrasonography. 28 patients in the STER group and 25 patients in the ESD group.Tumor diameter, operation time, length of hospital stay, and intraoperative and postoperative complications were compared.Results Compared with the ESD group, the t-values of the STER group were 1.51 and 0.19, respectively. There was no significant difference(P>0.05), but the diameter of the tumor was significantly larger than that of the ESD group [(1.61±0.99)cm vs(0.94±0.48)cm], statistically significant(t =3.19, P <0.05);the complete resection rates of ESD group and STER group were 100% and 92.85%, respectively. The incidence of hemorrhage, perforation and subcutaneous emphysema in the two groups were different. There was no statistical significance(P>0.05), but the incidence of hypothermia in the STER group was significantly lower than that in the ESD group, which was 3.57%(1/28) vs 28.00%(7/28), with statistics meaning(χ^2=4.39, P<0.05). Conclusion Endoscopic minimally invasive surgery for the treatment of lower esophageal masses is safe and effective. The postoperative recovery is faster and the tumor is larger. Considering postoperative infection, STER has an advantage.