内镜黏膜下挖除术和隧道法内镜黏膜下切除术治疗食管胃交界处黏膜下肿瘤的效果对比

Comparison of Effects of Endoscopic Submucosal Excavation and Submucosal Tunnel Endoscopic Resection in the Treatment of Submucosal Tumors at Esophagogastric Junction

目的:对内镜黏膜下挖除术(ESE)和隧道法内镜黏膜下切除术(STER)治疗食管胃交界处黏膜下肿瘤的效果进行对比分析。方法:回顾性分析2017年6月-2020年10月福建省漳州市医院的100例食管胃交界处黏膜下肿瘤患者临床资料,根据治疗方法不同分为研究组与对照组,各50例。研究组采取STER治疗,对照组采取ESE治疗。记录两组术中钛夹使用数量、手术时间及住院时间;比较术前及术后1周时,两组血清肿瘤标志物[细胞角蛋白19片段(CYFRA21-1)、糖类抗原19-9(CA19-9)、鳞状细胞癌抗原(SCC)]水平;比较两组术后2周内并发症发生情况;记录两组术后肿瘤残留情况及术后18个月内肿瘤复发情况。结果:两组术中钛夹使用数量及住院时间比较,差异均无统计学意义(P>0.05),研究组手术时间较对照组短(P<0.05);两组术前及术后1周时CYFRA21-1、CA19-9及SCC水平比较,差异均无统计学意义(P>0.05);术后2周内,两组并发症发生率比较,差异无统计学意义(P>0.05);两组肿瘤残留率及复发率比较,差异均无统计学意义(P>0.05)。结论:ESE与STER用于治疗食管胃交界处黏膜下肿瘤均可获得良好疗效,而STER可进一步缩短手术时长。

Objective:To compare and analyze the effects of endoscopic submucosal excavation(ESE) and submucosal tunnel endoscopic resection(STER) in the treatment of submucosal tumors at esophagogastric junction.Method:The clinical data of 100 patients with submucosal tumors at esophagogastric junction treated in Zhangzhou Municipal Hospital of Fujian Province from June 2017 and October 2020 were retrospectively analyzed.The patients were divided into study group and control group according to the different treatment methods,with 50cases in each group.Study group was treated with STER and control group was treated with ESE.The number of titanium clips used during surgery,surgical time and hospital stay were recorded in the two groups.The levels of serum tumor markers [cytokeratin 19 fragment(CYFRA21-1),carbohydrate antigen 19-9(CA19-9),squamous cell carcinoma antigen(SCC)] were compared between the two groups before and 1 week after surgery.Complications were compared between the two groups within 2 weeks after surgery.The postoperative tumor residual status and tumor recurrence within 18 months after surgery were recorded in the two groups.Result:There were no significant differences in the number of titanium clips used surgery and hospital stay between the two groups(P>0.05),and the surgical time in the study group was shorter than that in the control group(P<0.05).There were no significant differences in the levels of CYFRA21-1,CA19-9 and SCC between the two groups before and 1 week after surgery(P>0.05).There was no significant difference in the incidence rate of complications between the two groups within 2 weeks after surgery(P>0.05).There were no statistically significant differences in the tumor residual rate and recurrence between the two groups(P>0.05).Conclusion:Both ESE and STER have good therapeutic effects on submucosal tumors at esophagogastric junction,and STER can further shorten the operation time.