Chen Tao, Zhou Ping-Hong, Chu Yuan, Zhang Yi-Qun, Chen Wei-Feng, Ji Yuan, Yao Li-Qing, Xu Mei-Dong
*Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai, China †Endoscopy Research Institute of Fudan University, Shanghai, China ‡Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China.
Ann Surg. 2017 Feb;265(2):363-369. doi: 10.1097/SLA.0000000000001650.
The aim of this study is to evaluate the long-term outcomes of a large series of patients treated with submucosal tunneling endoscopic resection (STER).
STER is a newly developed treatment for upper gastrointestinal submucosal tumors originating from the muscularis propria layer. Recently, reports about STER are increasing, but a large study with long-term follow-up is little known.
In a retrospective study, a total of 180 patients with upper gastrointestinal submucosal tumors undergoing STER were included from June 2011 to May 2013. Clinicopathological, endoscopic, and follow-up data were collected and analyzed.
The en bloc resection was achieved in 90.6% of patients and the complications rate was 8.3%. Based on statistical analysis, tumors with irregular shape and greater size were the significant contributors to piecemeal resection and long operative times. Besides tumor shape and size, tumor in deep muscularis propria and long operative time were also risk factors of complications. The median hospitalization time was 3.2 days. All of the complications were cured by conservative treatment. A median follow-up of 36 months was available and all patients were free from local recurrence or distant metastasis during the study period.
STER is an effective and safe methodology for the resection of upper gastrointestinal submucosal tumors. Tumor size and shape impact on the piecemeal resection rate and procedural difficulty. STER for large tumors with irregular shape in the deep muscularis propria is also feasible but associated with relatively high risks of piecemeal resection and complications.
本研究旨在评估接受黏膜下隧道内镜切除术（STER）治疗的大量患者的长期疗效。
STER是一种新开发的用于治疗起源于固有肌层的上消化道黏膜下肿瘤的方法。最近，关于STER的报道不断增加，但一项长期随访的大型研究鲜为人知。
在一项回顾性研究中，纳入了2011年6月至2013年5月期间接受STER治疗的180例上消化道黏膜下肿瘤患者。收集并分析临床病理、内镜及随访数据。
90.6%的患者实现了整块切除，并发症发生率为8.3%。基于统计分析，形状不规则和体积较大的肿瘤是导致切除不完整和手术时间延长的重要因素。除肿瘤形状和大小外，肿瘤位于固有肌层深层和手术时间长也是并发症的危险因素。中位住院时间为3.2天。所有并发症均通过保守治疗治愈。中位随访时间为36个月，在研究期间所有患者均无局部复发或远处转移。
STER是一种切除上消化道黏膜下肿瘤的有效且安全的方法。肿瘤大小和形状会影响切除不完整率和手术难度。对于位于固有肌层深层、形状不规则的大肿瘤，STER也是可行的，但切除不完整和并发症的风险相对较高。
