Objective: To evaluate the short-term outcomes and safety of submucosal tunneling endoscopic resection (STER) for submucosal tumors (SMT) originating from muscularis propria (MP) layer at esophagogastric junction. Methods: The clinical data of 31 patients with SMT originating from MP layer at esophagogastric junction underwent STER were collected and retrospectively analyzed. Results: The success rate of STER of the thirty-one patients was 100%. The mean tumor size was (2.5±1.3) cm and the average operative time was (95.9±56.7) min. Perforation occurred in 3 patients and was successfully clipped by endo-clips during operation. One patient developed delayed bleeding and the bleeding was stopped by endoscopic hemostasis. Twenty-nine leiomyomas and two stromal tumors (GIST) were finally pathologically diagnosed. No local recurrence and distant metastasis were noted during the mean 15.4 months follow-up of 20 cases. According to the lesion size, 31 patients who received STER were divided into two groups. The operation time of maximum diameter ≥3.5 cm group was (134.0±70.6) min, significantly longer than (80.3±42.6) min of maximum diameter <3.5 cm group (P=0.014). However, the en bloc removal rate, postoperative hospital stay and the complication incidence between the two groups had no obvious differences (P>0.05). Univariate analysis showed that the piecemeal removal group had longer tumor diameter, higher incidence of irregular tumor morphology, and longer operative time than the en bloc removal group (all P<0.05). Stepwise logistic regression analysis showed that irregular shape was a risk factor for failure of en bloc removal (OR=18.000, 95% CI: 1.885~171.88, P=0.012). Conclusion: As a new method of minimally invasive treatment, STER technology appears to be a safe and effective option for patients with SMT originating from MP layer at esophagogastric junction.
目的： 探讨内镜经黏膜下隧道肿瘤切除术(STER)治疗食管胃结合部的固有肌层来源黏膜下肿瘤(SMT)的短期疗效和安全性。 方法： 回顾性分析接受STER治疗的31例食管胃结合部固有肌层来源SMT患者的临床资料。 结果： 31例患者手术成功率为100%，切除肿瘤的长径为(2.5±1.3)cm，平均手术时间为(95.9±56.7)min。3例患者出现术中穿孔，均使用金属夹成功夹闭，1例患者出现术后迟发性出血。术后病理诊断为平滑肌瘤29例，间质瘤2例。其中20例患者术后经过平均15.4个月的随访，未见局部复发和远处转移。长径≥3.5 cm组手术时间为(134.0±70.6)min，较长径<3.5 cm组[(80.3±42.6)min]有所延长(P＝0.014)，但两组间整块取出率、术后住院时间及术后并发症并无明显差异(均P>0.05)。单因素分析显示，分块取出组较整块取出组肿瘤长径较长、肿瘤形态不规则发生率高、手术时间延长(均P<0.05)。多因素分析显示，肿瘤形态不规则是食管胃结合部固有肌层来源SMT进行STER治疗整块取出的危险因素(OR＝18.000, 95% CI为1.885～171.880, P＝0.012)。 结论： 作为一种新的微创治疗方法，内镜经黏膜下隧道肿瘤切除术治疗食管胃结合部固有肌层来源的SMT具备较好的短期疗效及安全性。.
Keywords: Esophagogastric junction; Muscularis propria layer; Submucosal tumors; Submucosal tunneling endoscopic resection.