Wang Lei, Ren Wei, Zhang Zhimei, Yu Jing, Li Yihui, Song Yuankun
Endoscopic Center, Department of Gastroenterology, The Second Hospital of Shandong University, 247 Beiyuan St., Tianqiao, Jinan, 250033, Shandong, China,
Surg Endosc. 2013 Nov;27(11):4259-66. doi: 10.1007/s00464-013-3035-z. Epub 2013 Aug 17.
Esophageal leiomyoma is benign and often asymptomatic, but if the tumor is too large or obstructive, it should be resected. The aim of this study was to compare a novel approach, endoscopic submucosal tunnel dissection (ESTD), with a more established method, endoscopic submucosal dissection (ESD).
This was a retrospective study of 39 patients in Chongqing Xinqiao Hospital, China, undergoing resection for leiomyoma >2 cm in diameter, or 1.5-2.0 cm in diameter with symptoms of obstructive dysphagia. Epidemiological data, presenting symptoms, diagnostic investigations, tumor location, histopathological findings, and safety and efficacy of surgical resection were analyzed.
Mean tumor sizes in the ESTD (n = 18; mean age = 36.7 ± 6.3 years) and ESD (n = 21; age = 41.0 ± 4.4 years) groups were 3.3 ± 0.7 and 3.0 ± 0.4 cm, respectively. The male:female ratio was 25:14, with a distribution of lesions among the lower, middle, and upper esophagus of 22:14:3. Operating time was significantly shorter (p < 0.05) for ESTD (67.5 ± 9.5 min) than for ESD (87.2 ± 7.7 min), while incision healing was faster (p < 0.05) for ESTD (14.7 ± 2.5 days) than for ESD (57.9 ± 7.5 days). Hospital stay was also shorter (p < 0.05) for ESTD (2.3 ± 0.5 days) than for ESD (5.7 ± 1.0 days). Bleeding was the only complication with ESTD (3/18 patients), with no significant difference in the incidence of complications between groups. ESTD was rapidly learned by surgeons.
ESTD is a safe and effective treatment for esophageal leiomyoma, with advantages over ESD.
食管平滑肌瘤是良性的，通常无症状，但如果肿瘤过大或造成梗阻，则应进行切除。本研究的目的是比较一种新方法，即内镜黏膜下隧道剥离术（ESTD），与一种更成熟的方法，即内镜黏膜下剥离术（ESD）。
这是一项对中国重庆新桥医院39例直径大于2 cm或直径1.5 - 2.0 cm且有梗阻性吞咽困难症状的平滑肌瘤患者进行切除手术的回顾性研究。分析了流行病学数据、临床表现、诊断检查、肿瘤位置、组织病理学结果以及手术切除的安全性和有效性。
ESTD组（n = 18；平均年龄 = 36.7 ± 6.3岁）和平滑肌瘤切除术组（n = 21；年龄 = 41.0 ± 4.4岁）的平均肿瘤大小分别为3.3 ± 0.7 cm和3.0 ± 0.4 cm。男女比例为25:14，病变在下、中、上段食管的分布为22:14:3。ESTD的手术时间（67.5 ± 9.5分钟）明显短于ESD（87.2 ± 7.7分钟）（p < 0.05），而ESTD的切口愈合时间（14.7 ± 2.5天）比ESD（57.9 ± 7.5天）更快（p < 0.05）。ESTD的住院时间（2.3 ± 0.5天）也比ESD（5.7 ± 1.0天）更短（p < 0.05）。出血是ESTD唯一的并发症（18例患者中有3例），两组并发症发生率无显著差异。外科医生能很快学会ESTD。
ESTD是治疗食管平滑肌瘤的一种安全有效的方法，优于ESD。
