摘要
目的探究上消化道同部位浅表性肿瘤合并黏膜下肿瘤的临床病理特征及消化内镜超级微创手术(super minimally invasive surgery,SMIS)的疗效。方法回顾性分析2011年1月—2021年12月解放军总医院第一医学中心9例上消化道同部位浅表性肿瘤合并黏膜下肿瘤,并经消化内镜SMIS治疗的患者资料。收集患者的基础信息、内镜诊治、病理结果及随访等资料,分析其临床病理特征,以病理为金标准评价SMIS有效性,以并发症的发生率评价SMIS的安全性。结果9例患者中男8例、女1例,年龄为(61.6±11.7)岁,主要症状为腹痛(3例)、腹部不适(2例)、吞咽困难(1例)。其中7例患者术前诊断为浅表性肿瘤,手术过程中发现黏膜下肿瘤;术前诊断为浅表性肿瘤合并黏膜下肿瘤、黏膜下肿瘤的患者各1例。常见发病部位依次为食管3例、胃窦3例、贲门2例、胃底1例。所有病变的巴黎分型为Ⅰ型或Ⅱa及其组合类型。最常见的病理类型为早期癌合并平滑肌瘤(5例)。所有病变达到整块切除;除1例水平切缘提示低级别上皮内瘤变外,余下均得到完整切除。无出血、穿孔、感染等并发症发生。9例患者均成功进行了随访,随访时间为19~81个月,无复发或转移情况。结论上消化道同部位浅表性肿瘤合并黏膜下肿瘤患者症状多不典型,内镜下表现多为隆起型或部分隆起型,术前诊断多为浅表性肿瘤,诊疗过程中偶然发现黏膜下肿瘤,最常见的病理类型为早期癌合并平滑肌瘤。对于这类复杂病变,消化内镜SMIS治疗是一种安全且有效的方式。
Objective To explore the clinical characteristics of superficial neoplasia associated with submucosal tumor(SMT)located at the same position and the efficacy of endoscopic super minimally invasive surgery(SMIS).Methods Data of 9 patients who were diagnosed as having superficial neoplasia associated with SMT at the same position in the upper digestive tract and treated with digestive endoscopic SMIS at the First Medical Center of PLA General Hospital from January 2011 to December 2021 were retrospectively analyzed.Data including basic information,endoscopic diagnosis and treatment,pathological results and follow-up of these patients were collected to analyze their clinicopathological characteristics.The postoperative pathology and incidence of complications were used as the gold standard to assess the effectiveness and safety of SMIS.Results In the 9 patients,there were 8 males and 1 female with mean age of 61.6±11.7 years.The main symptoms were abdominal pain in 3 cases,abdominal discomfort in 2 cases,and dysphagia in 1 case.Seven patients were diagnosed as having superficial neoplasia before surgery,while SMT was found during surgery.One patient with superficial neoplasia associated with SMT and 1 with SMT were diagnosed before the surgery.The common sites of the lesion were esophagus(3 cases),gastric antrum(3 cases),cardia(2 cases)and fundus(1 case).The Paris classification of all lesions was typeⅠ,Ⅱa or combinations.The most common pathological type was early cancer with leiomyoma in 5 cases.All lesions met the criteria of en bloc resection.One lesion had positive lateral margin with low-grade intraepithelial neoplasia,four were all completely resected.No complications such as bleeding,perforation or infection occurred in this study.Follow-up date were available in all cases with a mean period of 19-81 months and no recurrence or metastasis was discovered.Conclusion The symptoms of patients with superficial neoplasia associated with SMT located at the same position are often atypical.The endoscopic type o
作者
朱宝杰
柴宁莉
刘圣圳
陈倩倩
令狐恩强
Zhu Baojie;Chai Ningli;Liu Shengzhen;Chen Qianqian;Linghu Enqiang(Department of Gastroenterology,The First Medical Center of PLA General Hospital,Beijing 100853,China)
出处
《中华消化内镜杂志》
CSCD
2023年第8期610-615,共6页
Chinese Journal of Digestive Endoscopy
基金
国家重点研发计划 (2022YFC2503600)。
关键词
上消化道
浅表性肿瘤
黏膜下肿瘤
超级微创手术
有效性
安全性
Upper gastrointestinal tract
Superficial neoplasia
Submucosal tumor
Super minimally invasive surgery
Safety
Efficiency
