内镜切除与胸腔镜手术治疗最大径3.5~7.0 cm食管固有肌层肿瘤的对比分析

Comparison between endoscopic resection and thoracoscopic surgery for maximum diameter 3.5-7.0 cm esophageal submucosal tumors originating from the muscularis propria layer

目的探讨内镜切除治疗最大径3.5~7.0 cm食管固有肌层肿瘤的有效性、安全性,并将其与胸腔镜手术进行对比。方法回顾性收集2016年1月至2022年4月郑州大学第一附属医院经内镜切除或胸腔镜手术治疗的最大径3.5~7.0 cm食管固有肌层肿瘤患者的临床数据,分析并比较内镜切除与胸腔镜手术治疗患者的流行病学资料、肿瘤相关资料、手术相关资料、并发症、随访结果等。结果共纳入患者79例,其中内镜组43例(经隧道内镜下肌层剥离术25例,内镜下肌层剥离术18例),胸腔镜组36例。两组患者性别、年龄、肿瘤位置、肿瘤纵径、肿瘤横径、肿瘤病理类型比较,差异均无统计学意义(P>0.05)。两组患者手术成功率均为100%。与胸腔镜组相比,内镜组手术时间短[(95.47±33.87)min vs(114.97±29.17)min],住院时间短,住院费用少,但整块切除率低(67.4%vs 88.9%),差异均有统计学意义(P<0.05)。内镜组术后胃管留置率较胸腔镜组低(34.9%vs 94.4%),抗生素使用时间、禁食时间、胃管留置时间较胸腔镜组短,发热、胸腔积液、胸痛发生率较胸腔镜组低,差异均有统计学意义(P<0.05)。两组患者瘘、气体相关并发症、肺部炎症发生率比较,差异无统计学意义(P>0.05)。随访1~36个月,无患者出现肿瘤复发和转移。结论内镜切除是治疗最大径3.5~7.0 cm食管固有肌层肿瘤的一种安全、有效的方式。而且,与胸腔镜手术相比,内镜切除创伤小、恢复快,住院费用少,住院时间短,术后并发症发生率低,患者生活质量较高。

Objective To investigate the efficacy and safety of endoscopic resection for maximum diameter 3.5-7.0 cm esophageal submucosal tumors originating from the muscularis propria layer,and compare its efficacy and safety with thoracoscopic surgery.Methods We retrospectively collected the clinical data of patients with maximum diameter 3.5-7.0 cm esophageal submucosal tumors originating from the muscularis propria layer who underwent endoscopic resection or thoracoscopic surgery in the First Affiliated Hospital of Zhengzhou University from Jan.2016 to Apr.2022.The epidemiological data,tumor related data,operation related data,complications and follow-up results were compared between endoscopic resection and thoracoscopic surgery.Results A total of 79 patients were enrolled,including 43 patients in the endoscopic group[tunneling endoscopic muscularis dissection(t-EMD)25 patients;endoscopic muscularis dissection(EMD)18 patients]and 36 patients in the thoracoscopic group.There was no significant difference between the two groups in gender,age,tumor location,tumor transverse diameter,tumor longitudinal diameter,tumor pathologic type(P>0.05).The success rate of tumors resection of both groups was 100%.Compared with the thoracoscopic group,the endoscopic group had shorter operation time[(95.47±33.87)min vs(114.97±29.17)min],shorter length of hospital stay,less medical cost,lower complete resection rate(67.4%vs 88.9%)(P<0.05).The postoperative indwelling rate of gastric tube in the endoscopic group was lower than those in the thoracoscopic group(34.9%vs 94.4%,P<0.05),the antibiotic use time,fasting time and gastric tube indwelling time were shorter than those in the thoracoscopic group(P<0.05),and the incidence of fever,pleural effusion and chest pain was lower than that in the thoracoscopic group(P<0.05).There was no significant difference in the incidence of fistula,gas-related complication and pneumonia between the two groups(P>0.05).Follow-up for 1-36 months,there was no recurrence and metastasis in both groups.Conclusion Endoscopic resection is an effective and safe method for the treatment of maximum diameter 3.5-7.0 cm esophageal submucosal tumors originating from the muscularis propria layer.In addition,compared with thoracoscopic surgery,endoscopic resection has the advantages of less trauma,faster recovery,less medical cost,shorter length of hospital stay,lower incidence of postoperative complications and higher quality of life.