Zhu Lin-Lin, Wu Jun-Chao, Wang Yi-Ping, He Du, Zhang Wen-Yan, Gan Tao, Yang Jin-Lin
Department of International Medical Center, West China Hospital of Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041 Sichuan, China.
Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041 Sichuan, China.
Gastroenterol Res Pract. 2019 Mar 12;2019:2943232. doi: 10.1155/2019/2943232. eCollection 2019.
This study reports the outcomes of endoscopic submucosal single-tunnel dissection or endoscopic submucosal multi-tunnel dissection for the treatment of esophageal neoplastic lesions of at least three-quarters of the esophageal circumference, including circumferential superficial esophageal neoplastic lesions. From July 2014 to February 2018, a total of 124 lesions underwent endoscopic submucosal tunnel dissection at our hospital. One to four submucosal tunnels were created in the oral to anal direction. Of the 124 lesions, there were 83 noncomplete circumferential lesions and 41 circumferential lesions. Endoscopic submucosal single-tunnel dissection was performed in 54 patients, two-tunnel dissection in 43 patients, three-tunnel dissection in 19 patients, and four-tunnel dissection in 8 patients. The mean dissection speed was 22.8 ± 12.7 mm/min. En bloc dissection was achieved in all lesions, and the R0 resection rate was 70.2 percent. No matter how large the lesion area was, there were no significant differences in the dissection speed and the R0 resection rate when lesions were at least three-quarters of the esophageal circumference. Esophageal stricture was observed in 54 patients and was relieved by placement of a retrievable metal stent or by endoscopic water balloon dilation. No recurrence was noted after 19.1 ± 12.4 months of follow-up. Our large sample size study showed that endoscopic submucosal tunnel dissection showed effectiveness and safety for the treatment of large superficial esophageal neoplastic lesions at least three-quarters of the esophageal circumference, including circumferential superficial esophageal neoplastic lesions.
本研究报告了内镜黏膜下单隧道剥离术或内镜黏膜下多隧道剥离术治疗食管周径至少四分之三的食管肿瘤性病变（包括环周浅表食管肿瘤性病变）的结果。2014年7月至2018年2月，我院共124例病变接受了内镜黏膜下隧道剥离术。在口侧至肛侧方向创建了1至4条黏膜下隧道。124例病变中，83例为非完全环周病变，41例为环周病变。54例患者行内镜黏膜下单隧道剥离术，43例患者行双隧道剥离术，19例患者行三隧道剥离术，8例患者行四隧道剥离术。平均剥离速度为22.8±12.7毫米/分钟。所有病变均实现整块切除，R0切除率为70.2%。无论病变面积多大，当病变至少占食管周径的四分之三时，剥离速度和R0切除率均无显著差异。54例患者观察到食管狭窄，通过置入可回收金属支架或内镜水囊扩张得以缓解。随访19.1±12.4个月后未发现复发。我们的大样本研究表明，内镜黏膜下隧道剥离术治疗食管周径至少四分之三的大浅表食管肿瘤性病变（包括环周浅表食管肿瘤性病变）具有有效性和安全性。
