常规内镜黏膜下剥离术与经内镜黏膜下隧道剥离术治疗食管大面积黏膜病变的疗效及并发症分析

目的研究常规内镜黏膜下剥离术(ESD)与经内镜黏膜下隧道剥离术（ESTD）治疗食管大面积黏膜病变的疗效及术后并发症发生情况，初步分析并发症发生的危险因素。方法分析2014年1月1日至2015年7月15日在我院消化内镜中心行ESD或ESTD的早期食管病变患者的临床资料，分析其整块切除率、治愈性切除率、术后并发症发生率，并通过单因素分析及多因素分析初步预测并发症发生的危险因素。结果共50例患者纳入研究，成功实施53次手术，其中ESD组6例，ESTD组47例，男30例，女20例，平均年龄（61.9±6.8）岁，平均手术时间（83.57±32.33） min，平均剥离面积(14.82±3.18) cm²，平均剥离速度为(17.67±3.12） mm²/ min。整块切除率为94.34%，治愈性切除率为84.90% 。术中出血1例，穿孔1例。术后有45例（84.90%）患者出现不同程度发热，13例(24.53%)患者发生食管狭窄，手术时间〔比值比（OR）为1.040，95%可信区间（CI）为1.007~1.075）及病变环周程度（OR为9.972,95%CI为1.221~81.416）与其发生相关。8例(15.09%)患者有术后切缘残留，病变面积（OR为1.145,95%CI为1.013~1.294）是影响其发生的唯一危险因素。结论 ESD及ESTD治疗早期食管病变安全、有效，整块切除率高，出血、穿孔等发生率低，但其治疗大面积食管病变时，易发生食管狭窄、切缘残留等严重并发症，需积极防治。

英文摘要:

Objective To determine the influence of location, depth and size of upper gastrointestinal （GI）submucosal tumors (SMTs) on the success of submucosal tunneling endoscopic resection (STER). Methods Patient records of 31 cases with upper GI SMTs who had STER between Jan. 1, 2014 and June 30, 2015 in West China Hospital of Sichuan University were retrieved. The success of STER was determined by its efficiency, complete resection rate, and incidence of complications. Results Of the 31 cases, 29 were treated successfully, with an average of （13.76±9.70） min and （32.00 ±27.35） min for tunnel formation of esophageal and stomach mucosal tumors respectively ( P=0.045). The 2 unsuccessful cases were gastric tumors. SMTs resection for mucous layer and muscularis propria took （17.50±9.06） min and （36.24±15.68） min, respectively ( P=0.004). SMTs resection for tumors diameter <2.0 cm and ≥2.0 cm took （25.78±12.13）min and （39.73±19.23） min, respectively ( P=0.023). Six cases of gastric tumors from muscularis propria had complications (19.4%) during or after surgery. Conclusion Location, depth and size of upper GI SMTs has implications on duration of different STER stages, which may determine complete resection rate and incidence of complications.

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