内镜经黏膜下隧道切除术治疗上消化道黏膜下肿瘤的研究

目的探讨上消化道黏膜下肿瘤（SMTs）的部位、来源层次、大小在内镜经黏膜下隧道切除术（STER）的各个环节如何影响STER的成功率及并发症发生率。方法收集2014年1月1日至2015年6月30日在四川大学华西医院内镜中心行STER治疗的31例上消化道SMTs患者的临床资料并进行分析。结果 31例上消化道SMTs中，29例（93.5%）完成肿瘤切除，失败的2例均为胃部肿瘤。完成切除的29例患者食管与胃黏膜下肿瘤隧道建立时间分别为（13.76±9.70） min、（32.00±27.35） min， P=0.045；黏膜层与固有肌层SMTs的肿瘤切除时间分别为（17.50±9.06） min、（36.24±15.68） min， P=0.004；肿瘤最大径＜2.0 cm与≥2.0 cm的SMTs切除时间分别为（25.78±12.13） min、（39.73±19.23） min， P=0.023。31例STER患者在术中或术后出现并发症共6例（19.4%），均为胃部肿瘤，肿瘤均来源于固有肌层。结论上消化道SMTs的部位、来源层次及肿瘤大小可影响STER的不同手术阶段耗用时间，亦是影响手术成功率及并发症发生率的重要因素。

英文摘要:

Objective To analysis the risk factors of lymph node metastasis (LNM) in superficial esophageal squamous cell carcinoma (SESCC). Methods The clinical data and pathological results of 344 SESCC patients, who underwent surgical treatments between January 2009 and December 2013 in West China Hospital, Sichuan University, were analyzed retrospectively. Clinicopathologic characteristics were compared between different histological types, and their possible relationships with LNM were explored by univariate and multivariate analysis. Results There were no LNM found in the patients with tumor limited to the mucous, tumor diameter ＜3 cm, highly and moderate differentiated SESCC. Univariate analysis showed that tumor diameter ( P=0.004)，depth of tumor invasion ( P=0.009)，histological type ( P=0.030) and lymphatic involvement ( P=0.002) were correlated with LNM. Multivariate analysis revealed that tumor diameter ( P=0.007)，depth of tumor invasion ( P=0.003)，histological type ( P=0.010)and lymphatic involvement ( P<0.001) were independent risk factors of LNM. Conclusion To the patients with low risk of LNM, such as tumor limited to the mucous, tumor diameter ＜3 cm, and highly and moderate differentiation, endoscopic excision may be considered as an absolute indications.

查看全文查看/发表评论下载PDF阅读器

关闭