240例上消化道黏膜下肿瘤内镜治疗的疗效及并发症评估

Evaluation of the efficacy and complications of endoscopic treatment of 240 cases of upper gastrointestinal submucosal tumors

目的探究上消化道黏膜下肿瘤(SMT)患者的临床特点及影响SMT患者术后并发症及住院花费的临床因素。方法收集2012年1月至2019年6月于山东大学附属山东省立医院就诊的240例SMT患者的临床资料,统计分析入组SMT患者的临床特点、病理类型、治疗方案及治疗效果。结果本研究共入组240例SMT患者,其中男性101例(42.1%),女性139例(57.9%);平均发病年龄为54.19岁;通过超声胃镜确定SMT大小、部位及起源,食管57例(23.8%)、胃食管结合部位7例(7.1%)、胃163例(67.9%)、十二指肠3例(1.3%),SMT平均大小为1.12 cm,153例(71.5%)起源于固有肌层,37例(17.7%)起源于黏膜肌层,24例(11.2%)起源于黏膜下层;69例(28.8%)患者给予内镜黏膜下剥离术(ESD)治疗,117例(48.8%)患者给予内镜黏膜下挖除术(ESE),28例(11.7%)患者给予内镜全层切除术(EFR),26例(10.7%)患者给予经黏膜下隧道内镜肿瘤切除术(STER);病理类型以平滑肌瘤(117,49.2%)和间质瘤(78,32.8%)为主。237例(98.8%)患者于内镜下成功治疗,整块切除率达到90.4%(217/240)。患者的平均手术时间为58.37 min,平均住院10.07 d,平均住院花费35830.3元。术后共有17例(7.1%)患者出现并发症,其中10例(4.2%)患者给予保守治疗后症状缓解,7例(2.9%)患者给予积极干预后缓解,无死亡或远期并发症病例。手术时长≥55 min、SMT≥2 cm为SMT患者术后发生并发症的高危因素,手术时间≥55 min、SMT≥2 cm、未能整块切除及使用内镜吻合夹系统OTSC是住院花费的正性影响因素。结论内镜下切除是治疗SMT安全有效的方式,早期发现、早期治疗、缩短手术时间是降低SMT患者术后并发症发生率及减少患者住院花费的有效途径。

Objective To explore the clinical characteristics of upper gastrointestinal submucosal tumors(SMT)and clinical factors affecting postoperative complications and hospitalization costs of SMT patients.Methods The clinical data of 240 SMT patients treated in Shandong Provincial Hospital during Jan.2012 and Jun.2019 were collected,and the clinical characteristics,pathological types,treatment modalities and therapeutic effects were analyzed.Results The patients included 101 male(42.1%)and 139 female(57.9%),mean age 54.19 years,and mean size of SMT 1.12 cm.The tumors were located in the esophagus in 57 cases(23.8%),in the gastroesophageal junction in 17 cases(7.1%),in the stomach in 163 cases(67.9%),and in the duodenum in 3 cases(1.3%).Endoscopic submucosal dissection(ESD)was performed in 69 patients(28.8%),endoscopic submucosal excavation(ESE)in 117 patients(48.8%),endoscopic full-thickness resection(EFR)in 28 patients(11.7%),and submucosal tunneling endoscopic resection(STER)in 26 patients(10.7%).The main pathological types were leiomyoma(117,49.2%)and stromal tumor(78,32.8%).Altogether 237 patients(98.8%)were successfully treated,with 90.4%(217/240)en bloc resection rate.The mean operation time was 58.37 minutes,hospital stay 10.07 days,and hospitalization costs 35830.3 yuan.Complications were observed in 17 patients(7.1%),10(4.2%)of whom relieved after conservative treatment and 7(2.9%)received active interventions such as endoscopic hemostasis,gastrointestinal decompression and puncture drainage.No death or long-term complications occurred.Operation time≥55 min and SMT≥2 cm were the risk factors of postoperative complications;meanwhile,operation time≥55 min,SMT≥2 cm,failure of en bloc resection and use of OTSC increased hospitalization costs.Conclusion Endoscopic resection is a safe and effective treatment modality of SMT.Early detection,early treatment and short operation time are effective ways to reduce the incidence of postoperative complications and hospitalization costs.