经黏膜下隧道内镜切除术治疗食管重复囊肿策略和并发症分析

Strategies and complications of submucosal tunneling endoscopic resection in the treatment of esophageal duplicated cysts

目的探讨经黏膜下隧道内镜切除术(STER)治疗食管重复囊肿(EDC)的策略和并发症。方法收集浙江省台州医院消化内科2013年1月至2019年12月收治的STER治疗并经病理检查确诊为EDC的11例住院患者资料,总结患者的临床表现、CT表现、内镜下表现、术后疗效、并发症、术后组织病理学表现等。结果11例患者中男6例,女5例,年龄为13~67岁,平均年龄为(43.0±18.2)岁。1例表现为进食哽噎感,1例嗳气,4例上腹部胀痛,余5例无特异性症状。11例患者胃镜下病灶均表现为食管腔内半球形或丘状、表面光滑的黏膜下肿物,触之质地较软;超声内镜下均表现为位于食管固有肌层、边界清楚的低回声团块。CT检查示9例患者有纵隔内类圆形、低密度囊性肿物,其中7例轻度强化,囊肿最大径为1.5~4.4 cm,平均最大径为(2.8±0.8)cm,多数(7例)患者病灶最大径为2~3 cm;另2例患者CT检查仅表现为食管壁略增厚。5例EDC发生于食管下段水平纵隔内。11例患者均行STER治疗,手术过程顺利,其中6例单纯行STER完整切除囊肿,5例行STER+残余囊壁氩气刀烧灼术。术后病理检查示6例为先天性食管囊肿,5例为食管壁内支气管源性囊肿。11例患者中位随访时间(范围)为42个月(12~86个月)。10例患者术后均恢复良好,未发现病灶局部复发、恶变、转移;1例复发,再次行STER+残余囊壁氩气刀烧灼术治愈。11例患者术中、术后均未发生大出血、食管瘘、纵隔感染、死亡等并发症。结论STER治疗EDC微创、安全、有效,可作为EDC一种新的治疗方法。

Objective To explore the strategies and complications of the submucosal tunneling endoscopic resection(STER)in the treatment of esophageal duplicated cyst(EDC).Methods From January 2013 to December 2019,at Department of Gastroenterology,Taizhou Hospital of Zhejiang Province,the clinical data of 11 hospitalized patients with EDC diagnosed by pathological examination who underwent STER were collected.The clinical featured,computed tomography(CT)findings,endoscopic findings,postoperative efficacy,complications and pathological results after operation were summarized.Results Among the 11 patients,there were 6 males and 5 females,the age ranged from 13 to 67 years,and the mean age was(43.0±18.2)years.One case presented with swallowing obstruction,1 case with belching,4 cases with upper abdominal pain,and the remaining 5 cases had no specific clinical symptoms.Under endoscopy,the lesions of 11 patients were hemispherical or mound-shaped with smooth surface submucosal masses in the esophageal cavity,which were soft to touch.Under endoscopic ultrasonography,they all appeared as hypoechoic masses with clear boundary located in the esophageal muscularis propria.The results of CT scan of 9 patients showed round low-density cystic masses,among them 7 cases showed mild enhancement.The maximum diameter of the cysts was 1.5 to 4.4 cm,with mean maximum diameter being(2.8±0.8)cm,and the maximum diameter of most patients(7 cases)were 2 to 3 cm.The other two patients showed only slightly thickened esophageal wall on CT.Five lesions occurred in the horizontal mediastinum of the lower esophagus.All the 11 patients underwent STER operation successfully,among them 6 patients received simple STER and the cysts were completely resected,and the other 5 patients received STER and cauterization with argon ion for the residual cyst wall.The pathological results after operation indicated that 6 cases were congenital esophageal cysts and 5 cases were bronchogenic cysts.The median follow-up time(range)of 11 patients was 42 months(12-86 months).Ten patients recovered well after the operation,and local recurrence,malignant transformation or metastasis were not found.One case had recurrence,and was treated with STER and cauterization with argon ion for residual cyst wall and cured.No complications such as bleeding,fistula,mediastinal infection or death occurred during and after operation in all the 11 patients.Conclusions STER is a minimally invasive,safe and effective treatment for EDC,and may be a new treatment for EDC.