内镜黏膜下剥离术及全层剥离术治疗上消化道黏膜下肿瘤197例分析

目的探讨内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）及全层剥离术（endoscopic full-thickness resection，EFR）治疗上消化道黏膜下肿瘤的有效性及安全性。方法回顾性分析消化科住院治疗的上消化道黏膜下肿瘤病人197例，均接受ESD或EFR手术，统计治疗切除率、手术时间、术中穿孔率、术后出血率及术后病理情况。结果197例中154例起源于黏膜下层，行ESD治疗，均完整剥离病灶，ESD平均手术时间（病灶标记至完整剥离成功）为（24.0±3.6）min；所有ESD病人术后均无出血发生，术中均无穿孔，均经金属钛夹成功封闭创面。43例起源于固有肌层及与浆膜层紧密粘连，遂行EFR。42例一次完整剥离成功，均经胃镜下金属钛夹及尼龙绳荷包缝合成功封闭创面；1例因瘤体较大，病变粘连、剥离困难，改用外科手术。EFR平均手术时间为（52.0±9.7）min，术后均无出血发生，术中均主动穿孔。ESD或EFR术后病理及免疫组织化学诊断为平滑肌瘤75例、异位胰腺43例，间质瘤39例、脂肪瘤26例，囊肿4例、神经内分泌肿瘤3例，神经鞘瘤3例、腺肌瘤2例，血管瘤1例、淋巴管1例。术后随访3~18个月，中位随访时间7个月，均未复发。结论ESD及EFR技术可以安全完整切除上消化道黏膜下肿瘤，并提供完整可靠的病理诊断，具有创伤小、恢复快的优点，值得临床进一步推广。

Value of endoscopic submucosal dissection and endoscopic full-thickness resection in the treatment of upper gastrointestinal submucosal tumors:197 cases analysis

ObjectiveTo assess the efficacy and safety of endoscopic submucosal dissection(ESD) and endoscopic full-thickness resection(EFR) in the treatment of the upper gastrointestinal submucosal tumors(SMT).MethodsThe clinical data of 197 patients with upper gastrointestinal SMT were retrospectively analyzed.All patients were treated with ESD or EFR.The tumor resection rate, operation time, intraoperative perforation rate, postoperative bleeding rate and histopathological results in the patients were evaluated.ResultsAmong the 197 patients, 154 cases originated from submucosa, were treated with ESD, and the lesions were completely stripped.The average operative time(from lesion labeling to complete dissection) of ESD was (24.0±3.6)min, no postoperative bleeding occurred, the perforation occurred during the operation, and the wound was successfully closed by titanium clips.Forty-three cases originated from submucosa, the tumors tightly adhered to the serous membrane layer, and were treated with EFR.Complete dissections in 42 cases were successfully performed, and the wound was successfully closed by titanium clips and nylon pocketbook suture under gastroscope.One case was changed to surgical operation due to the large tumor body and difficulty in adhesion and dissection.The mean operation time of EFR was (52.0±9.7)min, no hemorrhage occurred after operation, and the aortic perforation in the patients were found during EFR.The results of pathological and immunohistostaining examination identified the leiomyoma in 75 cases, ectopic pancreas in 43 cases, stromal tumor in 39 cases, lipoma in 26 cases, cyst in 4 cases, neuroendocrine tumor in 3 cases, schwannoma in 3 cases, adenomyoma in 2 cases, hemangioma in 1 case and lymphangioma in 1 case.All patients were followed up for 3 to 18 months, the median follow-up time was 7 months, and there was no recurrence case.ConclusionsESD and EFR technology can safely and completely remove the upper gastrointestinal SMT, and provide a complete and reliable pathological diagnosis.With the advantages of small trauma and quick recovery, it is worthy of further clinical promotion.