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中华胃肠内镜电子杂志

中华胃肠内镜电子杂志 ›› 2024, Vol. 11 ›› Issue (02) : 88 -93. doi: 10.3877/cma.j.issn.2095-7157.2024.02.004

论著

一种改良内镜黏膜下挖除术治疗胃黏膜下小肿物的临床研究
姚双喆1, 荆洋1, 王邦茂1, 刘文天1, 郑忠青1,†()   
  1. 1. 300052　天津，天津大学医科大学总医院消化科
  • 收稿日期:2023-08-03 出版日期:2024-05-15
  • 通信作者: 郑忠青
  • 基金资助:
    国家自然科学基金(82170558)

A clinical study of modified endoscopic submucosal excavation for the treatment of small gastric submucosal tumors

Shuangzhe Yao1, Yang Jing1, Bangmao Wang1, Wentian Liu1, Zhongqing Zheng1,†()   

  1. 1. Department of Gastroenterology and Hepatology.Tianjin Medical University General Hospital, Tianjin 300052, China
  • Received:2023-08-03 Published:2024-05-15
  • Corresponding author: Zhongqing Zheng
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引用本文：

姚双喆, 荆洋, 王邦茂, 刘文天, 郑忠青. 一种改良内镜黏膜下挖除术治疗胃黏膜下小肿物的临床研究[J]. 中华胃肠内镜电子杂志, 2024, 11(02): 88-93.

Shuangzhe Yao, Yang Jing, Bangmao Wang, Wentian Liu, Zhongqing Zheng. A clinical study of modified endoscopic submucosal excavation for the treatment of small gastric submucosal tumors[J]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2024, 11(02): 88-93.

目的

内镜黏膜下挖除术(ESE)是一种被广泛接受的消化道黏膜下肿瘤(SMT)的切除方法。本研究评价改良ESE，即一点注射C型切开的ESE方法(CESE)治疗胃黏膜下小肿瘤的临床效果及可行性。

方法

回顾性分析2016年1月至2020年8月经天津医科大学总医院消化科内镜室行内镜下治疗的87例胃黏膜下小肿瘤(SMT，肿瘤长径≤2 cm)患者资料，按治疗方式分为C-ESE组(40例)和传统ESE组(47例)，比较两组的手术时间、手术速度、黏膜下注射时间和次数、整块切除率、R0切除率、术中超声内镜(EUS)使用情况及术后并发症发生率情况。

结果

两组基本资料比较差异均无统计学意义(P>0.05)。CESE组手术时间(22.2±5.8)min，传统ESE组为(35.4±10.1)min，差异有统计学意义(P<0.001)；CESE组手术速度(9.1±6.6)mm2/min，快于传统ESE组的(4.7±4.7)mm2/min (P<0.001)；CESE组黏膜下注射次数1(1，1)次，少于传统ESE组的3(3，4)次，差异有统计学意义(P<0.001)。C-ESE组手术过程中均未使用术中EUS协助，和传统ESE组(7/47)相比存在统计学差异(P＝0.014)。两组在整块切除率、R0切除率及术后并发症发生率方面无统计学差异(P>0.05)。两组患者均随访超过1年。所有患者均无需补充外科治疗，在随访期间，所有患者均未发生并发症和复发情况。

结论

对于胃SMT较小(肿瘤长径≤2 cm)的患者，采用C-ESE是可行且可靠的，比传统ESE手术更快，且大大减少了暴露病变的难度和术中EUS协助的发生率，是一种安全有效的治疗方式。

关键词: 消化道黏膜下肿瘤, 内镜黏膜下挖除术, C型切开法
Objective

Endoscopic submucosal excavation (ESE) is a widely accepted method for the resection of submucosal tumors (SMT).This study evaluated the clinical effecacy and feasibility of modified ESE in the treatment of small gastric submucosal tumors, namely Ctype endoscopic submucosal excacation(CESE).

Methods

The retrospective analysis was performed on data of 87 patients who underwent ESE for small gastric submucosal tumors (longest diameter≤2 cm) at the Department of Endoscopy in Tianjin Medical University General Hospital from January 2016 to August 2020.Patients were divided into the CESE group (n=40) and the conventional ESE group (n=47). Eendoscopic operation time, operation speed, time and number of submucosal injections, en bloc resection rate, R0 resection rate, rate of intraoperative EUS and postoperative complications of the two groups were compared.

Results

There was no statistically significant differences in basic information between the two groups (P>0.05). Endoscopic operation time was 22.2±5.8 min in the CESE group and 35.4±10.1 min in the conventional ESE group with statistically significant difference (P<0.001). Endoscopic operation speed in the CESE group was 9.1±6.6 mm2/min, which was faster than 4.7±4.7 mm2/min in the conventional ESE group (P<0.001). The number of submucosal injections in the CESE group was less than that in the conventional ESD group [1 (1, 1) vs 3 (3, 4), P< 0.001].In the conventional ESE group, 7 patients received intraoperative EUS, while no intraoperative EUS occurred in the CESE group (P=0.014). There was no significant differences in en bloc resection rate, R0 resection rate and postoperative complications between the two groups (P>0.05).All patients were followed up for more than 1 year. None of the patients required additional surgical treatment, and no complications or recurrence occurred during the follow-up period.

Conclusion

C-ESE is a feasible and reliable treatment strategy for small gastric SMT (tumor longest diameter≤2 cm), which can shorten the endoscopic operation time, reduce the difficulty of lesion exposure and avoid the assistance of intraoperative EUS.

Key words: Submucosal tumors, Endoscopic submucosal excavation, Ctype incision
图1 C-ESE术式示意图注：A：胃体黏膜下病变；B：省略边缘标记，直接一点黏膜下注射；C：半环周C形切开暴露病变；D：剥离病变同传统ESD；E：处理封闭创面；F：完整剥离病变
表1 不同术式治疗的胃小SMT患者基线临床资料比较[例(%)]
项目 全部(n＝87) C-ESE组(n＝40) 传统ESE组(n＝47) P值
患者特征        
年龄(岁) 53.1±10.8 54.4±12.4 52.0±9.2 0.308
性别       0.154
男 42(48.3) 16(40) 26(55.3)  
女 45(51.7) 24(60) 21(44.7)  
病变特征        
位置       0.653
胃底 37(42.5) 15(37.5) 22(46.8)  
胃体 31(35.6) 16(40) 15(31.9)  
胃窦 19(21.8) 9(22.5) 10(21.3)  
长径(mm) 12.2±5.2 12.8±4.3 11.66±5.8 0.320
组织学       0.610
间质瘤 31(35.6) 14(35) 17(36.2)  
平滑肌瘤 34(39.1) 18(45) 16(34)  
脂肪瘤 7(8.0) 3(7.5) 4(8.5)  
异位胰腺 13(14.9) 5(12.5) 8(17)  
神经鞘瘤 2(2.3) 0(0) 2(4.3)  
病变深度       0.661
黏膜下层 22(25.3) 11(27.5) 11(23.4)  
固有肌层 65(74.7) 29(72.5) 36(76.6)  
表2 C-ESE组与传统ESE组手术情况结果比较
项目 全部(n＝87) C-ESE组(n＝40) 传统ESE组(n＝47) P值
手术时间(min，±s) 29.4±10.7 22.2±5.8 35.4±10.1 0.000
黏膜下注射时间(s，±s) 28.1±18.6 9.6±2.1 43.8±9.7 0.000
黏膜下注射次数[次，M(Q1，Q3)] 3(1，3) 1(1，1) 3(3，4) 0.000
剥离时间(min，±s) 18.0±8.9 12.3±4.4 22.9±8.8 0.000
手术速度(mm2/min，±s) 6.8±6.0 9.1±6.6 4.7±4.7 0.001
术中EUS使用[n(%)] 7(8) 0(0) 7(14.9) 0.014
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