ESD与STER在上消化道黏膜下肿物切除中的选择与对比研究

The selection and comparison of endoscopic resection techniques in upper gastrointestinal submucosal tumor

目的评价内镜黏膜下剥离术(ESD)和黏膜下隧道肿瘤切除术(STER)在上消化道黏膜下肿物切除中的选择与应用,以指导临床选择合理的内镜技术。方法回顾性收集2012年6月-2018年10月在广州市第一人民医院消化疾病中心就诊并接受ESD或STER治疗的所有患者,筛选出上消化道黏膜下肿物患者共64例,其中ESD组34例,STER组30例,详细分析并归纳患者临床资料及术后随访资料。结果①ESD组及STER组在治疗效果及预后方面无差异,两组肿物完整切除率均为100%,术后随访两组均无局部复发及远处转移;②ESD组内镜下表现以腔内生长及肿物形态较规则为主,瘤体主要位于胃底、胃体大弯;STER组内镜下表现以腔外生长及肿物形态不规则为主,瘤体主要位于食管、胃体小弯。③STER组手术时间少于ESD组,差异有统计学意义。结论对于上消化道黏膜下肿瘤患者,ESD和STER是一种安全和有效的治疗手段;若瘤体形态欠规则及腔外生长为主,位于食管、胃体小弯,STER为优先选择。

Objective To evaluate the selection and comparison of endoscopic resection techniques represented by endoscopic submucosal dissection(ESD) and submucosal tunnel tumor resection(STER) for the treatment of upper gastrointestinal submucosal tumors, so as to guide selection of endoscopic resection techniques. Methods A total of 64 cases of upper gastrointestinal submucosal masses were screened from all patients receiving ESD and STER treatment in the digestive diseases center of Guangzhou First People’s Hospital between June 2012 and October 2018, including 34 cases in the ESD group and 30 cases in the STER group.Clinical data and postoperative follow-up data were summarized and analyzed in detail. Results ① There was no difference in characteristics of cases between this two groups. The rate of complete resection was both 100% and no local recurrence or distant metastasis were found.② Endoscopic appearance of ESD group was mainly endogenous with regular tumor which was mainly located at the side of gastric fundus and stomach greater curvature. STER group were mainly exogenous with irregular tumor which mainly located at the side of esophagus and stomach lesser curvature.③ The operative time in STER group were less than ESD group, the difference was statistically significant(P<0.05). Conclusion ESD and STER are both safe and effective for the treatment of upper gastrointestinal submucosal tumors;if the tumor is irregular and mainly exogenous growth, located at the side of esophagus, stomach lesser curvature, STER would be preferred.