保留黏膜层的内镜黏膜下挖除术治疗胃黏膜下肿瘤的有效性分析

Efficacy analysis of endoscopic submucosal excavation with mucosal layer preservation for gastric submucosal tumors

摘要:

目的 比较保留黏膜层的内镜黏膜下挖除术（endoscopic submucosal excavation，ESE）与传统ESE治疗起源于固有肌层、长径≤2 cm的胃黏膜下肿瘤（submucosal tumors，SMT）的有效性及安全性。方法 回顾性分析2021年11月至2022年11月于黑龙江省医院消化病院接受保留黏膜层的ESE（保留黏膜组，30例）或传统ESE（不保留黏膜组，30例）治疗的长径≤2 cm起源于固有肌层的胃SMT患者资料。比较两组患者的一般资料（性别、年龄、肿瘤发生部位及大小），分析内镜相关治疗结果，包括整块切除率、手术时间、术中出血量、术中穿孔率及术后并发症（出血、穿孔、感染）发生率、经济效益、术后住院时间等指标。结果 两组患者的一般资料差异无统计学意义（P>0.05）。保留黏膜组与不保留黏膜组的整块切除率［100.0%（30/30）比90.0%（27/30），P=0.237］、术中出血量［（23.34±14.68）mL比（23.67±14.73）mL，t=0.085，P=0.932］、术中穿孔率［0.0%（0/30）比16.7%（5/30），P=0.052］及术后住院时间［（5.17±1.46）d比（5.93±1.59）d，t=1.939，P=0.057］差异均无统计学意义。两组患者均无术后出血、穿孔、发热和腹膜炎发生。但保留黏膜组手术时间低于不保留黏膜组，分别为（47.07±14.03）min及（59.47±16.75）min（t=3.107，P=0.003）；保留黏膜组住院费用显著低于不保留黏膜组，分别为（22 109.68±3 960.65）元及（28 378.64±3 842.31）元（t=6.222，P=0.001）。结论 保留黏膜层的ESE与传统ESE治疗起源于固有肌层的长径≤2 cm的胃SMT安全有效。与传统ESE相比，保留黏膜层的ESE手术时间较短、医疗费用更低。

Abstract:

Objective To compare the efficacy and safety of endoscopic submucosal excavation (ESE) with mucosal layer preservation and traditional ESE for patients with small (≤2 cm) gastric submucosal tumors (SMT) originating from muscularis propria. Methods A retrospective study was performed on patients with gastric SMT (≤2 cm) originating from muscularis propria treated by ESE with mucosal layer preservation (mucosal layer preservation group, 30 cases) or traditional ESE (non-mucosal layer preservation group, 30 cases) in Digestive Disease Hospital, Heilongjiang Provincial Hospital from November 2021 to November 2022. Baseline characteristics (gender, age, tumor location and size) and endoscopy-related treatment outcomes including en bloc resection rate, operation time, intraoperative blood loss, intraoperative perforation rate and postoperative complications (bleeding, perforation, infection) rate, economic benefits, and postoperative hospitalization time were compared. Results There was no significant difference in the baseline characteristics between the two groups (P>0.05). As for en bloc resection rate [100.0% (30/30) VS 90.0% (27/30), P=0.237], intraoperative blood loss (23.34±14.68 mL VS 23.67±14.73 mL, t=0.085, P=0.932), intraoperative perforation rate [0.0% (0/30) VS 16.7% (5/30), P=0.052], and hospitalization time (5.17±1.46 days VS 5.93±1.59 days, t=1.939, P=0.057), there were no significant differences between the mucosal layer preservation group and the non-mucosal layer preservation group. No postoperative bleeding, perforation, fever or peritonitis occurred in either group. However, the operation time was shorter in the mucosal layer preservation group than that in the non-mucosal layer preservation group (47.07±14.03 min VS 59.47±16.75 min, t=3.107, P=0.003). The hospitalization expenses in the mucosal layer preservation group were significantly lower than those in the non-mucosal layer preservation group (22 109.68±3 960.65 yuan VS 28 378.64±3 842.31 yuan, t=6.222, P=0.001). Conclusion Both ESE with mucosal layer preservation and traditional ESE are safe and reliable for patients with small (≤2 cm) gastric SMT originating from muscularis propria. Compared with traditional ESE, the mucosal layer preservation technique demonstrates a shorter operation time and reduces hospitalization expenses.