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

doi:10.3969/j.issn.1006-5725.2024.18.008

Abstract

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.

Key words: pericardial submucosal tumor, submucous tunnel endoscopic tumor resection, recurrence, quality of life, indicators of inflammation, immune index

CLC Number:

R735.1

Rui WANG,Duo LI,Zhao PENG,Lijun CUI,Xiang ZHANG,Kaili FAN,Wenyan. WU. Effect of endoscopic tumor resection by submucosal tunnel on recurrence in patients with submucosal tumors around cardia[J]. The Journal of Practical Medicine, 2024, 40(18): 2555-2560.

Figures/Tables 6

Fig.1

Tab.1

Tab.2

Tab.3

Tab.4

Tab.5

References 26

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 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 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 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 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 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 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 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 doi: 10.1002/deo2.282
13	LIBÂNIO 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 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 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 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 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 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 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 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 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 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 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 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 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 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 doi: 10.5946/ce.2019.161

组别	例数	整块切除/［例（%）］	治愈性切除/［例（%）］	住院时间/d	手术时间/min	治疗费用/万元	剥离速度/（mm²/min）
对照组	46	44（95.65）	45（97.83）	11.14 ± 1.27	83.86 ± 9.61	3.55 ± 0.50	15.11 ± 2.29
观察组	46	46（100.00）	46（100.00）	9.13 ± 0.92	114.09 ± 10.67	2.58 ± 0.58	21.91 ± 2.25
t/χ ² 值		0.511	0.345	8.693	14.278	8.591	14.366
P值		0.475	> 0.05	0.000	0.000	0.000	0.000

时间	组别	例数	QLQ-C46	KPS	PSQI
术前	对照组	46	38.96 ± 2.41	78.91 ± 6.11	7.14 ± 1.85
	观察组	46	39.25 ± 2.72	79.42 ± 5.08	6.88 ± 1.72
	t值		0.541	0.435	0.698
	P值		0.590	0.664	0.487
术后1周	对照组	46	45.27 ± 2.26^*	83.53 ± 3.10^*	5.09 ± 0.87^*
	观察组	46	52.42 ± 2.59^*	88.66 ± 3.14^*	3.26 ± 0.46^*
	t值		14.108	7.885	12.612
	P值		0.000	0.000	0.000

时间	组别	例数	IL-8/（ng/mL）	IL-6/（ng/L）	hs-CRP/（mg/L）
术前	对照组	46	0.95 ± 0.18	12.03 ± 2.17	9.82 ± 0.81
	观察组	46	0.92 ± 0.16	11.92 ± 3.03	9.91 ± 0.97
	t值		0.845	0.200	0.483
	P值		0.400	0.842	0.630
术后1周	对照组	46	0.71 ± 0.22^*	7.01 ± 1.24^*	5.92 ± 0.48^*
	观察组	46	0.44 ± 0.18^*	5.12 ± 1.17^*	4.60 ± 0.47^*
	t值		6.442	7.519	13.327
	P值		0.000	0.000	0.000

时间	组别	例数	CD4⁺/%	CD8⁺/%	CD4⁺/CD8⁺
术前	观察组	46	38.54 ± 3.23	29.87 ± 2.52	1.29 ± 0.53
	对照组	46	39.06 ± 3.35	30.06 ± 2.43	1.30 ± 0.39
	t值		0.758	0.368	0.103
	P值		0.451	0.714	0.918
术后1周	观察组	46	43.61 ± 1.61^*	26.71 ± 1.05^*	1.63 ± 0.22
	对照组	46	41.52 ± 1.42^*	28.24 ± 1.79^*	1.47 ± 0.17
	t值		6.603	5.000	3.903
	P值		0.000	0.000	0.000

组别	例数	皮下气肿	切口疼痛	反流	狭窄	切口感染	并发症发生率	复发率
对照组	46	1（2.17）	3（6.52）	2（4.35）	2（4.35）	2（4.35）	10（21.74）	1（2.17）
观察组	46	1（2.17）	1（2.17）	1（2.17）	0（0.00）	0（0.00）	3（6.52）	0（0.00）
χ ² 值							4.389	0.557^#
P值							0.036	-

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

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 6

References 26

Related Articles 15

Recommended Articles

Metrics

Comments

[1]	Tianyue CUI,Liquan OUYANG,Shengchu. ZHANG. Clinical efficacy of simple surgery and surgery combined with glucocorticoids in the treatment of mass type granulomatous mastitis [J]. The Journal of Practical Medicine, 2024, 40(9): 1268-1274.
[2]	Weitao HE,Xiaodi SHEN,Yangdi WANG,Jinfang DU,Xuehua LI,Shanshan XIONG,Zhoulei LI,Shaochun. LIN. Prediction of risks of early anastomotic recurrence following primary bowel resection in patients with Crohn′s disease based on preoperative magnetic resonance enterography [J]. The Journal of Practical Medicine, 2024, 40(5): 664-671.
[3]	Cui JI,Qinying WANG,Lei WANG,Yuan. WANG. Effect of cognitive⁃behavioral intervention under the family⁃based care model on continuing care of patients after aortic dissection surgery [J]. The Journal of Practical Medicine, 2024, 40(4): 566-570.
[4]	Juanjuan FENG,Zexing CHENG,Lu XIAO. The clinical value of NLRP3 inflammasome level combined with ECP/MPO ratio in predicting the recurrence of chronic sinusitis after endoscopic sinus surgery [J]. The Journal of Practical Medicine, 2024, 40(22): 3196-3201.
[5]	Shuling SUN,Yuling XING,Jiangmei GONG,Ni. ZHANG. The relationship and clinical risk assessment between trigeminal nerve atrophy and pontine angle and recurrence after percutaneous radiofrequency thermocoagulation in ITN patients [J]. The Journal of Practical Medicine, 2024, 40(15): 2133-2137.
[6]	Xiaojing CAI,Yonglian HUANG,Fei ZHOU,Xianwen. TANG. Clinical observation of umbilical moxibustion in treating chronic heart failure with Yang deficiency syndrome of blood stasis and water withdrawal [J]. The Journal of Practical Medicine, 2024, 40(14): 2021-2026.
[7]	Yanqing MAO,Ya′nan WANG,Jie. LI. The clinical symptoms， quality of life and laboratory indexes of newly diagnosed chronic obstructive pulmonary disease with hypertension [J]. The Journal of Practical Medicine, 2024, 40(11): 1549-1553.
[8]	Siqi NIAN,Lulu ZHAO,Baotong. HUA. Research progress in atrial arrhythmia recurrence after catheter ablation for atrial fibrillation [J]. The Journal of Practical Medicine, 2024, 40(10): 1338-1343.
[9]	YU Jiangtao , WANG Shijie, ZHANG Gaofei, DUAN Xinxin, HUO Qingfeng, ZHENG Shouhua, LIU Peiyu. . Predictive value of serum thyroglobulin and TSH for recurrence of differentiated thyroid cancer after total thyroidectomy without remnant ablation [J]. The Journal of Practical Medicine, 2023, 39(9): 1159-1163.
[10]	LIU Tingting, LUO Deqin, DENG Cheng, MENG Xubiao.. Expression of receptor tyrosine kinase⁃like orphan receptor 2 in papillary thyroid carcinoma and its clini⁃ cal significance [J]. The Journal of Practical Medicine, 2023, 39(8): 985-990.
[11]	AIZEZI Zu⁃ lifeiye, APAER Shadike, CAO Xinling, WANG Ying, TUXUN Tuerhongjiang, LI Tao, YANG Yuanyuan.. Effects of laparoscopic sleeve gastrectomy on weight loss and quality of life in obese patients [J]. The Journal of Practical Medicine, 2023, 39(7): 875-874.
[12]	WANG Xiaolu, YIN Zongsheng, LIU Yiming, MA Li, YU Xianshun.. Analysis of the curative effect and changes of spinopelvic parameters after multilevel lumbosacral fusion [J]. The Journal of Practical Medicine, 2023, 39(2): 224-229.
[13]	WEN Lifang , DING Jie. . Study on the relationship between the expression of SLIT3 and SPARCL1 protein and the recurrence after radical operation in cervical cancer [J]. The Journal of Practical Medicine, 2023, 39(15): 1907-1912.
[14]	FENG Qizhu, CHEN Xianzhi, SUN Jie, ZHANG Jian, WANG Qi. . Risk factors of choledocholithiasis recurrence in elderly patients with acute cholangitis after ERCP surgery [J]. The Journal of Practical Medicine, 2023, 39(15): 1945-1949.
[15]	WU Jun, CUI Weiyan, LI Ping, ZHANG Qingfeng, OU Yuezhen. . Life′s Simple 7 intervention to alleviate chemotherapy⁃related cardiovascular system damage in HER2 posi⁃ tive patients with breast cancer [J]. The Journal of Practical Medicine, 2023, 39(13): 1647-1651.