CAJ | 학술논문

目的：探讨及评价内镜隧道黏膜下肿瘤切除术（STER）治疗来源于食管固有肌层黏膜下肿瘤（SMTs）的有效性、安全性及相关并发症的处理。方法2011年11月至2013年7月期间，南方医科大学第三附属医院内镜中心经胃镜及超声胃镜诊断来源于食管固有肌层的黏膜下肿瘤并要求内镜微创治疗的患者13例，所有患者行STER治疗，完整切除病变并行病理及免疫组化检查，术后1～12个月随访观察治疗效果。结果13例患者食管SMTs均应用STER完整切除，完整切除率100%；其中固有肌浅层9例，深层4例；切除病变直径1.3～3.0 cm，中位直径2.0 cm；手术时间50～120 min，中位时间80 min。术后病理检查及免疫组织化染色证实平滑肌瘤11例，间质瘤2例，切缘均为阴性；术中发生单纯皮下气肿3例，均保守治疗后恢复；皮下气肿合并气胸及气腹1例，予术中胸腔闭式引流术及气腹针放气后顺利完成手术并恢复；术中出现隧道黏膜侧小破损2例，均予钛夹封闭，术后愈合良好，未发生隧道瘘；所有病例均无术后隧道内出血及感染。采用胃镜及超声内镜随访1～12个月，中位随访6个月，未见肿瘤残留及复发。结论 STER术治疗食管固有肌来源的黏膜下肿瘤是一种安全、有效的微创治疗方法，具有较好的临床应用前景，但应注意来源于固有肌深层的病变易出现严重并发症。
목적：탐토급평개내경수도점막하종류절제술（STER）치료래원우식관고유기층점막하종류（SMTs）적유효성、안전성급상관병발증적처리。방법2011년11월지2013년7월기간，남방의과대학제삼부속의원내경중심경위경급초성위경진단래원우식관고유기층적점막하종류병요구내경미창치료적환자13례，소유환자행STER치료，완정절제병변병행병리급면역조화검사，술후1～12개월수방관찰치료효과。결과13례환자식관SMTs균응용STER완정절제，완정절제솔100%；기중고유기천층9례，심층4례；절제병변직경1.3～3.0 cm，중위직경2.0 cm；수술시간50～120 min，중위시간80 min。술후병리검사급면역조직화염색증실평활기류11례，간질류2례，절연균위음성；술중발생단순피하기종3례，균보수치료후회복；피하기종합병기흉급기복1례，여술중흉강폐식인류술급기복침방기후순리완성수술병회복；술중출현수도점막측소파손2례，균여태협봉폐，술후유합량호，미발생수도루；소유병례균무술후수도내출혈급감염。채용위경급초성내경수방1～12개월，중위수방6개월，미견종류잔류급복발。결론 STER술치료식관고유기래원적점막하종류시일충안전、유효적미창치료방법，구유교호적림상응용전경，단응주의래원우고유기심층적병변역출현엄중병발증。
Objective To explore or evaluate the safety and efficacy and its complications of STER for esophageal SMTs originating from the muscularis propria(MP) layer. Methods A total of 13 patients who diagnosed with esophageal SMTs originated from the MP layer by endoscope and EUS, and demanded endoscopic resection in Endoscopy center of the Third Affiliated Hospital of Southern Medical University from November 2011 to July 2013. STER was applied to remove those tumors. The all lesions were successfully resected and definitely diagnosed by pathology, and the therapeutic effect and safety were followed-up(1-12 months). Results A total of 13 cases received STER, and were completely resected with an en bloc resection rate of 100. The median lesion size was 2.0 cm(range 1.3-3.0 cm), and the median operation time of STER were 80 min (range 50-120 min);9 cases originated from superficial MP layer and 4 from deep MP layer;Histopathological and immunohistochemical examinations confirmed that the lesions were leiomyomas(n=11), stromal tumors(n=2); both the lateral and basal margins of the specimens were free of tumor cells. 3 cases originated from deep MP layer developed subcutaneous emphysema only, all of them recovered uneventfully on conservative treatment. One suffered subcutaneous emphysema and pneumothorax, pneumoperitoneum, which recovered with closed drainage of pleural cavity or Puncturing;2 cases occurred mucosal tunneling perforation which was sutured by clips. None of the patients developed submucosal hematoma or infection. No tumor residual or recurrence was found during follow-up, and the median period was 6 months(range 1-12 months). Conclusions STER is a safe and effective method for resecting esophagus muscular propria layer tumors, which would has considerable application prospect, but attention should be paid to sources of serious complications from the muscularis deep lesions.