内镜黏膜下肿物挖除术及内镜经黏膜下隧道肿瘤切除术治疗胃食管连接处固有肌层肿瘤的对比分析

摘要:

目的 评价内镜黏膜下肿物挖除术（ESE）及内镜经黏膜下隧道肿瘤切除术（STER）治疗胃食管连接处固有肌层肿瘤的疗效及安全性。
方法 2013年1月至2015年12月，61例在第二军医大学附属长海医院行ESE治疗（ESE组，n=39）或STER治疗（STER组，n=22）的胃食管连接处固有肌层肿瘤患者的临床资料纳入回顾性总结，对比分析两组的治疗情况以及并发症发生情况。
结果 61例均为单发病灶，全部于内镜下成功切除。STER组手术平均耗时明显短于ESE组［（47.27±20.89）min比（66.56±40.07）min，P＜0.05］，术中钛夹平均使用量与ESE组相近［（7.10±5.57）枚比（8.00±1.88）枚，P＞0.05］，术后中位住院时间明显短于ESE组[3.00（1.25）d比4.00（1.00）d，P＜0.05]。仅ESE组发生术后迟发性出血1例，两组均无其他相关并发症发生。随访期内，两组复查胃镜均示切口愈合，原病变处均无肿瘤残留及复发。
结论 STER和ESE均可用于胃食管连接处固有肌层肿瘤的治疗，且STER相对更加安全和高效。

Abstract:

ObjectiveTo evaluate the efficacy and safety of endoscopic submucosal excavation（ESE） and submucosal tunneling endoscopic resection （STER） for gastroesophageal junction（GEJ） submucosal tumors （SMTs） originating from the muscularis propria（MP） layer. MethodsClinical data of sixty-one patients with GEJ SMTs originating from the MP layer who were treated with ESE（ESE group， n=39） or STER（STER group， n=22） between January 2013 and December 2015 in Changhai Hospital were retrospectively analyzed. Outcomes and complications in the two groups were compared. ResultsSingle lesion in 61 patients were all resected by therapeutic endoscopy successfully. Operation time in the STER group was shorter than that of the ESE group（47.27±20.89 min VS 66.56±40.07 min，P＜0.05）.There was no significant difference in number of hemostatic clips between the two groups［7.10±5.57 VS 8.00±1.88，P＞0.05］. Hospitalization time of STER group was shorter than that of the ESE group [3.0（1.25）d VS 4.0（1.00）d，P＜0.05]. One patient developed delayed hemorrhage in ESE group， while no other complications occurred in either group. The wound healed in both groups under gastroscopy， and no residual or recurrent tumors were detected during the follow-up period. ConclusionBoth STER and ESE can be used for GEJ SMTs originating from the MP layer， but STER is more safe and efficient.