影响源于固有肌层的食管黏膜下肿瘤行黏膜下隧道内镜切除术有效性和安全性的因素。
Factors affecting the effectiveness and safety of submucosal tunneling endoscopic resection for esophageal submucosal tumors originating from the muscularis propria layer.
机构信息
Department of Gastroenterology and Hepatology, Chinese People's Liberation Army General Hospital, Fuxing Road 28 Haidian District, Beijing, 100853, China.
出版信息
Surg Endosc. 2018 Mar;32(3):1255-1264. doi: 10.1007/s00464-017-5800-x. Epub 2017 Aug 25.
BACKGROUND AND AIMS
Submucosal tunneling endoscopic resection (STER) has been proved to be effective and safe for esophageal submucosal tumors (SMTs) originating from the muscularis propria (MP) layer. This study was aimed to further evaluate the effectiveness, safety, and influencing factors especially the types of mucosal incision of STER in a larger population.
METHODS
A total of 89 patients undergoing STER with esophageal SMTs were retrospectively enrolled in this study from May 2012 to November 2016. Clinicopathological, endoscopic, and adverse events (AEs) data were collected and analyzed. Different incision methods were compared to evaluate the optimum incision method.
RESULTS
There were 27 females and 62 males with mean age of 46.5 ± 10.3 years. The medium size of the tumors was 16.0 mm (ranging 10.0-60.0 mm). Inverted T incisions were made in 29 (32.6%) patients, transverse incisions in 12 (13.5%) while longitudinal incisions in 48 (53.9%). En bloc resection was achieved in 70 (78.7%) patients. The residual rate was 1.1% (1/89), and no recurrence was noted even after piecemeal resection. The rate of AEs was 21.3% (19/89), and all of the AEs were cured without intervention or treated conservatively without the need for surgery. The en bloc resection rate was comparable among the three incision groups (P = 0.868); however, the incidence of AEs in the inverted T incision was lower than that in the longitudinal incision (P = 0.003). Fewer clips were used in the inverted T incision group than in the transverse incision group (P = 0.003).
CONCLUSIONS
Although STER failed to achieve en bloc resection in 21.3% patients, it was still an effective therapy owing to low residual rate and no recurrence rate after piecemeal resection. STER was safe with no severe AEs; however, minor AEs were common. Inverted T incision seems to be the optimum entry point.
背景与目的
黏膜下隧道内镜切除术（STER）已被证明对起源于固有肌层（MP）的食管黏膜下肿瘤（SMT）是有效且安全的。本研究旨在更大的人群中进一步评估STER 的有效性、安全性和影响因素，特别是黏膜切开的类型。
方法
回顾性分析 2012 年 5 月至 2016 年 11 月期间 89 例接受STER 治疗的食管 SMT 患者的临床病理、内镜和不良事件（AE）数据。比较不同的切开方法，以评估最佳的切开方法。
结果
共有 27 名女性和 62 名男性，平均年龄为 46.5±10.3 岁。肿瘤的中位大小为 16.0mm（范围 10.0-60.0mm）。29 例（32.6%）采用倒置 T 型切口，12 例（13.5%）采用横切口，48 例（53.9%）采用纵切口。70 例（78.7%）患者达到整块切除。残瘤率为 1.1%（1/89），即使行分片切除也未见复发。AE 发生率为 21.3%（19/89），所有 AE 均未经治疗或保守治疗治愈，无需手术。三种切口组的整块切除率无差异（P=0.868）；然而，倒置 T 型切口的 AE 发生率低于纵切口（P=0.003）。倒置 T 型切口组使用的夹闭器少于横切口组（P=0.003）。
结论
尽管STER 在 21.3%的患者中未能达到整块切除，但由于分片切除后的残留率和复发率低，仍然是一种有效的治疗方法。STER 是安全的，无严重 AE；然而，小的 AE 很常见。倒置 T 型切口似乎是最佳的切入点。
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