临床研究

经黏膜下隧道内镜肿瘤切除术对贲门周围黏膜下肿瘤患者复发的影响

  • 王锐 ,
  • 李多 ,
  • 彭昭 ,
  • 崔利军 ,
  • 张翔 ,
  • 樊凯丽 ,
  • 吴文燕
展开
  • 河北北方学院附属第一医院消化内科 (河北 张家口 050051 )

收稿日期: 2024-04-16

  网络出版日期: 2024-09-30

基金资助

河北省医学科学研究重点课题计划项目(20200532);张家口市科技计划项目(2322038D)

Effect of endoscopic tumor resection by submucosal tunnel on recurrence in patients with submucosal tumors around cardia

  • Rui WANG ,
  • Duo LI ,
  • Zhao PENG ,
  • Lijun CUI ,
  • Xiang ZHANG ,
  • Kaili FAN ,
  • Wenyan. WU
Expand
  • Department of Gastroenterology,the First Affiliated Hospital of Hebei North University,Zhangjiakou 050051,China

Received date: 2024-04-16

  Online published: 2024-09-30

摘要

目的 分析经黏膜下隧道内镜肿瘤切除术(STER)对贲门周围黏膜下肿瘤(SMT)患者复发的影响。 方法 92例贲门周围SMT患者,用随机数字表法分为观察组和对照组各46例,分别予以STER、内镜黏膜下剥离术(ESD)治疗,两组均术后随访12个月。比较两组围术期指标、治疗效果,术前、术后1周生活质量、睡眠情况、炎症指标、免疫指标,术后1周并发症,术后12个月复发情况。 结果 与对照组比较,观察组手术时间更长,住院时间更短,治疗费用更低,剥离速度更快(P < 0.05)。与术前比较,术后1周两组匹兹堡睡眠质量指数(PSQI)评分,血清白细胞介素-8(IL-8)、白细胞介素-6(IL-6)、高敏C反应蛋白(hs-CRP)水平,全血CD8+水平降低,且观察组更低(P < 0.05)。与术前比较,术后1周两组生活质量核心46问卷调查(QLQ-C46)、卡式评分(KPS),全血CD4+、CD4+/CD8+水平升高,且观察组更高(P < 0.05)。术后1周,两组并发症发生率比较,观察组更低(P < 0.05),术后12个月两组复发率比较,差异无统计学意义(P > 0.05)。 结论 贲门周围SMT接受STER治疗的效果良好,可改善围术期指标,提高生活质量、睡眠情况,抑制机体炎症反应,改善免疫功能,并发症发生风险更低,且未增加复发情况。

本文引用格式

王锐 , 李多 , 彭昭 , 崔利军 , 张翔 , 樊凯丽 , 吴文燕 . 经黏膜下隧道内镜肿瘤切除术对贲门周围黏膜下肿瘤患者复发的影响[J]. 实用医学杂志, 2024 , 40(18) : 2555 -2560 . DOI: 10.3969/j.issn.1006-5725.2024.18.008

Abstract

Objective To analyze the effect of endoscopic tumor resection by submucosal tunnel (STER) on recurrence in patients with submucosal tumors (SMT) around cardia. Methods A total of 92 patients with SMT around cardia were selected and divided into the treatment group(n = 46) and the control group(n = 46) using random number table method. The treatment group and the control group were treated with STER and endoscopic submucosal dissection (ESD), respectively, and both groups were followed up for 12 months after surgery. Perioperative indexes, therapeutic effects, quality of life, sleep, inflammatory indexes, immune indexes before and 1 week after surgery, complications 1 week after surgery, recurrence 12 months after surgery were compared between the two groups. Results Compared with the control group, the surgery time of the treatment group was longer, the hospital stay was shorter and treatment cost were lower, and the stripping speed was faster (P < 0.05). Compared with before surgery, scores of Pittsburgh sleep Quality index (PSQI), serum levels of interleukin-8 (IL-8), interleukin-6 (IL-6), high-sensitive C-reactive protein (hs-CRP) and whole blood levels of CD8+ decreased in the two groups 1 week after surgery, and the levels were lower in the treatment group (P < 0.05). Compared with the preoperative results, the levels of whole blood CD4+ and CD4+/CD8+, scores of Quality of Life Core 46 Questionnaire (QLQ-C46), Karnofsky Score (KPS) were higher in the two groups 1 week after surgery, those in the treatment group was higher (P < 0.05). 1 week after surgery, the complication rate of the two groups was lower in the treatment group (P < 0.05), and 12 months after surgery, the recurrence rate of the two groups was not statistically significant (P > 0.05). Conclusion STER treatment for SMT around cardia was highly effective, resulting in superior perioperative outcomes, enhanced life and sleep quality, reduced systemic inflammation, and bolstered immune function. Moreover, it significantly lowered the risk of complications without raising the rates of recurrence.

参考文献

1 TANG Y, DENG X, YANG W, et al. Submucosal tunnel endoscopic resection for a large leiomyoma originating from the muscularis propria in the upper esophagus[J]. Rev Esp Enferm Dig, 2022, 114(6): 348-349.
2 张婧文, 曹新广, 符洋, 等. 2 ~ 5 cm胃间质瘤内镜与外科治疗疗效对比[J]. 实用医学杂志, 2022, 38(19): 2451-2456.
3 JIAO J, FAN X, LUO L, et al. Efficacy of endoscopic ultrasound and endoscopic resection for esophageal schwannoma[J]. Scand J Gastroenterol, 2023, 58(8): 963-969. doi:10.1080/00365521.2023.2185867
4 CHEN L, YE L, HU B. Gastrointestinal: Endoscopic submucosal tunnel dissection for an esophageal bronchogenic cyst[J]. J Gastroenterol Hepatol, 2023, 38(1): 9. doi:10.1111/jgh.15906
5 王强. 胃肠外科学[M]. 北京:人民军医出版社, 2001: 143-146.
6 ASOKAN S, PR G P, MATHIAZHAGAN T, et al. Association between intelligence quotient dental anxiety and oral health-related quality of life in children: A cross-sectional study[J]. Int J Clin Pediatr Dent, 2022, 15(6): 745-749. doi:10.5005/jp-journals-10005-2452
7 ISHIDA Y, KAMIBEPPU K, SATO A, et al. Karnofsky performance status and visual analogue scale scores are simple indicators for quality of life in long-term aya survivors who received allogeneic hematopoietic stem cells transplantation in childhood[J]. Int J Hematol, 2022, 116(5): 787-797. doi:10.1007/s12185-022-03426-5
8 SANCHO-DOMINGO C, CARBALLO J L, COLOMA-CARMONA A, et al. Brief version of the pittsburgh sleep quality index (b-psqi) and measurement invariance across gender and age in a population-based sample[J]. Psychol Assess, 2021, 33(2): 111-121. doi:10.1037/pas0000959
9 SHAO B Z, CHAI N L, LI L S, et al. Comparison between endoscopic submucosal tunnel dissection and endoscopic submucosal dissection for superficial neoplasia at esophagogastric junction: A case-matched controlled study of a single center from China[J]. Surg Endosc, 2022, 36(11): 8371-8378. doi:10.1007/s00464-022-09289-5
10 DI S, QIANG S, ZHIPENG Q, et al. Improved submucosal tunneling endoscopic resection with slant tunnel for submucosal tumors in proximal esophagus[J]. Surg Endosc, 2021, 35(7): 4055-4060. doi:10.1007/s00464-021-08503-0
11 SHI R Y, ZHAN S G, LI D F, et al. An unexpected gastric cardia submucosal lesion[J]. Rev Esp Enferm Dig, 2023, 115(8): 460-461.
12 SHIWAKU H, OKADA H, SHIWAKU A, et al. A case of endoscopic full-thickness resection for gastric gastrointestinal stromal tumor in the submucosal tunnel[J]. DEN Open, 2023, 4(1): e282. doi:10.1002/deo2.282
13 LIB?NIO D, PIMENTEL-NUNES P, BASTIAANSEN B, et al. Endoscopic submucosal dissection techniques and technology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review[J]. Endoscopy, 2023, 55(4): 361-389. doi:10.1055/a-2031-0874
14 WADHWA V, FRANCO F X, ERIM T. Submucosal tunneling endoscopic resection[J]. Surg Clin North Am, 2020, 100(6): 1201-1214. doi:10.1016/j.suc.2020.08.016
15 CHIU P W Y, YIP H C, CHAN S M, et al. Endoscopic full-thickness resection (EFTR) compared to submucosal tunnel endoscopic resection (STER) for treatment of gastric gastrointestinal stromal tumors[J]. Endosc Int Open, 2023, 11(2): E179-E186. doi:10.1055/a-1972-3409
16 LAMBIN T, RIVORY J, WALLENHORST T, et al. Endoscopic submucosal dissection: How to be more efficient?[J]. Endosc Int Open, 2021, 9(11): E1720-E1730. doi:10.1055/a-1554-3884
17 GENG Z H, ZHOU P H, CAI M Y. Submucosal tunneling techniques for tumor resection[J]. Gastrointest Endosc Clin N Am, 2023, 33(1): 143-154. doi:10.1016/j.giec.2022.07.002
18 GE P S, AIHARA H. Advanced endoscopic resection techniques: Endoscopic submucosal dissection and endoscopic full-thickness resection[J]. Dig Dis Sci, 2022, 67(5): 1521-1538. doi:10.1007/s10620-022-07392-0
19 LI P, MA B, GONG S, et al. Endoscopic submucosal tunnel dissection for superficial esophageal neoplastic lesions: A meta-analysis[J]. Surg Endosc, 2020, 34(3): 1214-1223. doi:10.1007/s00464-019-06875-y
20 DONATELLI G, CEREATTI F, DUMONT J L, et al. Submucosal tunnel endoscopic resection of gastric lesion before obesity surgery: A case series[J]. Obes Surg, 2020, 30(11): 4636-4642. doi:10.1007/s11695-020-04928-z
21 LIU J, WANG Y, LIU Z, et al. Submucosal tunneling endoscopic resection treatment of multiple gastrointestinal submucosal tumors[J]. J Gastroenterol Hepatol, 2021, 36(9): 2575-2580. doi:10.1111/jgh.15532
22 SHARZEHI K, SETHI A, SAVIDES T. AGA clinical practice update on management of subepithelial lesions encountered during routine endoscopy: Expert review[J]. Clin Gastroenterol Hepatol, 2022, 20(11): 2435-2443. doi:10.1016/j.cgh.2022.05.054
23 CHEN T, WANG G X, LIAN J J, et al. Submucosal tunneling endoscopic resection for submucosal tumors in the proximal esophagus[J]. J Am Coll Surg, 2022, 234(6): 1127-1135. doi:10.1097/xcs.0000000000000181
24 TANG Y, DENG X, CHENG Z, et al. Endoscopic ultasound miniprobe assists submucosal tunnel endoscopic resection of an esophageal subepithelial lesion[J]. Dig Liver Dis, 2022, 54(11): 1586-1587. doi:10.1016/j.dld.2022.05.012
25 BAPAYE J, GANDHI A, PITTANYANON R, et al. Modified submucosal tunneling endoscopic resection for postcricoid esophageal subepithelial tumor[J]. VideoGIE, 2022, 7(3): 91-94. doi:10.1016/j.vgie.2021.12.008
26 KAAN H L, HO K Y. Endoscopic full thickness resection for gastrointestinal tumors-challenges and solutions[J]. Clin Endosc, 2020, 53(5): 541-549. doi:10.5946/ce.2019.161
文章导航

/