术前隧道标记法在经黏膜下隧道内镜切除术中的应用

Application of Preoperative Tunnel Marking in Submucosal Tunnel Endoscopic Resection

目的探讨术前隧道标记法缩短经黏膜下隧道内镜切除术(STER)手术时间的临床效果。方法回顾性分析自2018年1月—12月医院消化内科收治的食管中下段及贲门固有肌层良性肿瘤患者40例临床资料,所有患者均行黏膜下隧道内镜切除术治疗。将术前行隧道黏膜下注射标记后再行黏膜下隧道内镜发现瘤体的20例患者作为A组,将常规经黏膜下隧道内镜发现瘤体的20例患者作为B组。比较A、B组从发现病灶、建立隧道至找瘤体时间,全程手术时间,手术瘤体大小以及距门齿平均距离;比较术后住院天数,术后有无感染、穿孔、出血等并发症,以及术后1、3、6月随访情况等指标。结果A组患者寻找瘤体时间、全程手术时间、并发症总发生率明显低于B组,且差异有统计学意义(P<0.05);A组患者术后1、3、6个月肿瘤残留或复发情况与B组相比,无统计学差异(P>0.05)。结论术前隧道标记法作为改良的经黏膜下隧道内镜切除术在缩短食管胃黏膜下肿瘤手术时间有一定优势,有助于减少发现瘤体时间,从而减少手术时间,减少术后并发症。

Objective To explore the clinical outcomes of preoperative tunnel marking to shorten the surgery time in submucosal tunnel endoscopic resection(STER).Methods A retrospective analysis was made on 40 patients with benign tumors in the middle-lower esophagus and muscularis propria of cardia.They were admitted by the gastroenterology department in our hospital from January to December 2018 and were treated by STER.They were divided into two groups averagely,group A managed with preoperative submucosal tunnel marking before undergoing submucosal tunnel endoscopy,while group B with the conventional one.Group A and group B were compared in terms of the time span from finding lesions,establishing tunnels to locating tumors,the entire surgery time,tumor size and the average distance from the incisor.Such indicators as postoperative inpatient stay,complications like infection,perforation and bleeding,and the follow-ups of 1,3 and 6 months respectively were also compared.Results Group A enjoyed a shorter time span of locating tumors,less entire surgery time and a lower total incidence than group B significantly(P<0.05).However,no significant difference was observed in aspects of residuals or recurrences after 1,3,6 months respectively between the two groups(P>0.05).Conclusion As an improved pattern of STER,preoperative tunnel marking has advantages such ascurtailing the surgery time of esophagogastric submucosal tumors.It helps decrease the time span of finding tumors,thus reducing the operation time and eliminating postoperative complications.