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中华胃肠内镜电子杂志

中华胃肠内镜电子杂志 ›› 2025, Vol. 12 ›› Issue (04) : 241 -245. doi: 10.3877/cma.j.issn.2095-7157.2025.04.004

论著

超级微创手术治疗胃多发黏膜下肿瘤的有效性及安全性研究
赵云云1,2, 杜晨2, 李惠凯2, 陈倩倩2,†(), 令狐恩强2,†()   
  1. 1100853　北京，解放军总医院解放军医学院
    2100853　北京，解放军总医院第一医学中心消化内科医学部
  • 收稿日期:2025-07-28 出版日期:2025-11-15
  • 通信作者: 陈倩倩, 令狐恩强
  • 基金资助:
    国家重点研发计划(2022YFC2503600)

Efficacy and safety of super minimally invasive surgery for multiple gastric submucosal tumors

Yunyun Zhao1,2, Chen Du2, Huikai Li2, Qianqian Chen2,†(), Enqiang Linghu2,†()   

  1. 1Chinese PLA Medical School, Beijing 100853, China
    2Department of Gastroenterology, The First Medical Center of PLA General Hospital, Beijing 100853, China
  • Received:2025-07-28 Published:2025-11-15
  • Corresponding author: Qianqian Chen, Enqiang Linghu
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引用本文：

赵云云, 杜晨, 李惠凯, 陈倩倩, 令狐恩强. 超级微创手术治疗胃多发黏膜下肿瘤的有效性及安全性研究[J/OL]. 中华胃肠内镜电子杂志, 2025, 12(04): 241-245.

Yunyun Zhao, Chen Du, Huikai Li, Qianqian Chen, Enqiang Linghu. Efficacy and safety of super minimally invasive surgery for multiple gastric submucosal tumors[J/OL]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2025, 12(04): 241-245.

目的

胃多发黏膜下肿瘤(SMT)的内镜治疗尚缺乏系统评估。本研究旨在分析超级微创手术(SMIS)，包括ESD、ESE、EFTR及STER治疗胃多发SMT的有效性及安全性。

方法

回顾性收集2013年1月至2025年3月经解放军总医院第一医学中心消化内科医学部诊断为胃多发SMT并首次行SMIS治疗的53例患者，分析患者的临床病理特征、手术方式、整块切除率、R0切除率、手术时间、主要不良事件、住院时间、手术费用及随访情况。

结果

本研究共纳入53例胃多发SMT患者，其中女39(73.6%)例、男14(26.4%)例，平均年龄(55.1±8.8)岁。共检出141个病变，139(98.6%)个病变成功实现内镜下切除，肿瘤中位大小为8 mm(范围：2~30 mm)。病理诊断结果显示，平滑肌瘤51(36.7%)个、神经内分泌肿瘤46(33.1%)个、胃肠道间质瘤34(24.5%)个、脂肪瘤4(2.9%)个，异位胰腺、神经鞘瘤、肌纤维母细胞瘤及平滑肌增生结节各1(各占0.7%)个。124(89.2%)个病变行经口超级微创非全层切除术、8(5.8%)个病变行经口超级微创全层切除术、7(5.0%)个病变行经隧道通道超级微创切除术。手术平均耗时(58.4±25.4)min。整块切除率达99.3%(138/139)，R0切除率为97.1%(135/139)。围手术期未发生严重不良事件。51例患者完成随访，中位随访时间22个月(范围：3~119个月)。随访发现非神经内分泌肿瘤复发率2.6%(1/39)，神经内分泌肿瘤复发率显著增高，达50 %(5/10)。患者术后中位住院时间6 d(IQR：5~7 d)。中位手术费用11 187.3元(IQR：8 851.8~14 348.3元)，中位住院总费用27 035.1元(IQR：24 671.4~36 580.8元)。

结论

本研究证实SMIS治疗胃多发黏膜下肿瘤是一种安全有效的治疗方法。

关键词: 胃黏膜下肿瘤, 超级微创手术, 多发病变, 非全层切除, 全层切除, 疗效
Objective

The endoscopic management of multiple gastric submucosal tumors (SMT) remains insufficiently systematically evaluated. This study aimed to assess the efficacy and safety of super minimally invasive surgery(SMIS), including endoscopic submucosal dissection (ESD), endoscopic submucosal excision (ESE), endoscopic full-thickness resection (EFTR), and submucosal tunneling endoscopic resection (STER), for treating multiple gastric SMT.

Methods

We retrospectively analyzed 53 patients diagnosed with multiple gastric SMT who underwent initial SMIS at the Department of Gastroenterology, First Medical Center of Chinese PLA General Hospital, between January 2013 and March 2025. Clinical-pathological characteristics, surgical approaches, en bloc resection rate, R0 resection rate, operative duration, major adverse events, hospitalization length, surgical costs, and follow-up outcomes were evaluated.

Results

This study enrolled 53 patients with multiple gastric SMT, including 39 (73.6%) females and 14 (26.4%) males, with a mean age of 55.1±8.8 years.A total of 141 tumor lesions were detected, with 139(98.6%) successfully removed by endoscopic resection.The median tumor size was 8 mm (range: 2-30 mm). Histopathological analysis revealed 51(36.7%) leiomyomas, 46(33.1%) neuroendocrine tumors, 34 (24.5%) gastrointestinal stromal tumors, 4 (2.9%) lipomas, and one case each (0.7%) of ectopic pancreas, schwannoma, myofibroblastoma, and hyperplastic smooth muscle nodule. Peroral super minimally invasive non-full-thickness resection was performed on 124 (89.2%) lesions, peroral super minimally invasive full-thickness resection on 8 (5.8%) lesions, and super minimally invasive resection via tunnel approach on 7 (5.0%) lesions.The mean operative duration was 58.4±25.4 minutes.The en bloc resection rate reached 99.3% (138/139), with an R0 resection rate of 97.1% (135/139). No severe adverse events occurred during the perioperative period.Among 51 patients who completed follow-up (median: 22 months; range: 3-119 months), the recurrence rate was 2.56%(1/39)for non-neuroendocrine tumors but significantly higher for neuroendocrine tumors at 50.00%(5/10). The median postoperative hospital stay was 6 days (IQR: 5-7), with median surgical costs of ￥11, 187.3 (IQR: 8, 851.8-14, 348.3) and total hospitalization costs of ￥27, 035.1 (IQR: 24, 671.4-36, 580.8).

Conclusion

This study demonstrates that SMIS is a safe and effective therapeutic approach for multiple gastric SMT.

Key words: Gastric submucosal tumor, Super minimally invasive surgery, Multiple lesions, Non-full-thickness resection, Full-thickness resection, Therapeutic efficacy
表1 胃多发黏膜下肿瘤患者的临床病理特征
项目 数值
年龄[(±s)，岁] 55.1±8.8
男/女 39/14
肿瘤大小[M(IQR)，mm] 8(5，10)
肿瘤位置(%)  
胃体 51.1(72/141)
胃底 37.6(53/141)
贲门 6.4(9/141)
窦体结合部 1.4(2/141)
胃窦 3.6(5/141)
肿瘤病理类型(%)  
平滑肌瘤 36.7(51/139)
神经内分泌肿瘤 33.1(46/139)
间质瘤 24.5(34/139)
脂肪瘤 2.9(4/139)
异位胰腺 0.7(1/139)
神经鞘瘤 0.7(1/139)
肌纤维母细胞瘤 0.7(1/139)
平滑肌增生结节 0.7(1/139)
表2 胃多发黏膜下肿瘤手术信息
项目 数值
整块切除率(%) 99.3(138/139)
R0切除率(%) 97.1(135/139)
复发率(%)  
非神经内分泌肿瘤 2.6(1/39)
神经内分泌肿瘤 50(5/10)
手术时间[(±s)，min] 58.4±25.4
术后严重并发症(%) 0
术后住院天数[M(IQR)，d] 6(5，7)
手术费用[M(IQR)，元] 11 187.3(8 851.8，14 348.3)
住院费用[M(IQR)，元] 27 035.1(24 671.4，36 580.8)
图1 胃多发黏膜下肿瘤患者随访信息
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