Song Shunzhe, Feng Mingliang, Zhou Huan, Liu Mengyuan, Sun Mingjun
Department of Gastroenterology, The First Hospital of China Medical University , Shenyang, China .
J Laparoendosc Adv Surg Tech A. 2018 Nov;28(11):1364-1370. doi: 10.1089/lap.2017.0607. Epub 2018 Sep 25.
The majority of submucosal tumors (SMTs) are benign. However, large SMTs with irregular outer shapes are proved to harbor a higher risk for malignancy. Submucosal tunneling endoscopic resection (STER) has emerged as a feasible technique for resecting SMTs.
To evaluate the safety and efficacy of STER for large and irregular SMTs with a diameter no <35 mm originating from the muscularis propria layer, and to share the technical skills of STER for complete and en bloc resection.
We retrospectively reported 10 cases in which the new technique of STER was performed to remove large and irregular SMTs with a diameter no <35 mm of upper gastrointestinal tract in our hospital between April 2014 and April 2017.
All 10 (100%) patients underwent STER successfully, with a mean operation time of 156 minutes. Among the 10 SMTs, 3 (30%) were located in the esophagus, 7 (70%) were in the cardia. All the SMTs had a maximum diameter no <35 mm, ranging from 35 to 100 mm. The mean size was 57.2 mm. En bloc resection was achieved in 8 (80%) of the tumors. Only two (20%) of the SMTs were resected into more than one piece. Complication occurred in 1 (10%) of the patients as a representation of pneumothorax. No recurrence was noted during a median follow-up of 15 months.
In this retrospective study, STER may be an effective and safe technique resecting large and irregular SMTs with a diameter no >40 mm in transverse diameter and no >100 mm in longitudinal diameter.
大多数黏膜下肿瘤（SMTs）是良性的。然而，已证实外形不规则的大型SMTs具有更高的恶变风险。黏膜下隧道内镜切除术（STER）已成为一种切除SMTs的可行技术。
评估STER治疗源于固有肌层、直径≥35mm的大型不规则SMTs的安全性和有效性，并分享STER完整整块切除的技术技巧。
我们回顾性报告了2014年4月至2017年4月在我院采用STER新技术切除上消化道直径≥35mm的大型不规则SMTs的10例病例。
所有10例（100%）患者均成功接受了STER治疗，平均手术时间为156分钟。在这10个SMTs中，3个（30%）位于食管，7个（70%）位于贲门。所有SMTs的最大直径≥35mm，范围为35至100mm。平均大小为57.2mm。8个（80%）肿瘤实现了整块切除。只有2个（20%）SMTs被切成了多块。1例（10%）患者出现气胸并发症。中位随访15个月期间未发现复发。
在这项回顾性研究中，STER可能是一种有效且安全的技术，可用于切除横径≤40mm、纵径≤100mm的大型不规则SMTs。
