| ObjectiveTo compare the efficacy and complications of endoscopic submucosal tunneling resection with endoscopic submucosal dissection in the treatment of upper gastrointestinal submucosal tumors,and explore the application value of endoscopic submucosal tunneling resection,in order to provide evidence for clinical practice.MethodsFrom January 2016 to August 2017,all patients were enrolled in the Department of Gastroenterology and Digestive Endoscopy from the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine.86 patients were initially diagnosed as upper gastrointestinal submucosal tumors by general endoscopy,endoscopic ultrasonography and upper abdominal CT,who were divided into the control group(endoscopic submucosal dissection group,ESD group)and the research group(submucosal tunneling endoscopic resection group,STER group)by the selection of the operation mode,including 45 cases in the ESD group and 41cases in the STER group.The operative time,bleeding rate and perforation rate,maximum diameter of lesion,length of wound surface,total resection rate,curative resection rate,hospitalization time,operation cost and other indexes were recorded and analyzed.Results1.The distribution of lesions:There were 45 patients in the ESD group,including 22 esophageal lesions,23 gastric lesions.There were 41 patients in the STER group,including 28 esophageal lesions,13 gastric lesions,χ~2=3.319,P=0.068.There was no significant statistics difference between the two groups on the distribution of lesion.2.The maximal path of lesion:The maximal path of lesions in the ESD group were 4 mm~40 mm,with an averaged of(22.19±9.46)mm.The maximal path of lesions in the STER group was 4 mm~35 mm,with an averaged of(12.36±7.38)mm,t=0.155,P=0.877,and the difference was not statistically significant.3.Wound length:The long diameter of the wounds in the ESD group were 14 mm~60 mm,with an averaged of(22.19±9.46)mm.The long diameter of the wounds in the STER group were 6 mm~36 mm,with an averaged of(14.33±7.30)mm,t=4.020,P=0.000,and the difference was statistically significant.4.Complications:The incidence of intraoperative bleeding was 11.1%in the ESD group,and 14.6%in the STER group,χ~2=0.239,P=0.625.There was no significant difference between the two groups.The incidence of delayed bleeding was 6.67%in the ESD group,and 9.76%in the STER group,χ~2=0.274,P=0.601.There was no significant difference between the two groups.The incidence of perforation was 20.0%in the ESD group,4.88%in the STER group,χ~2=4.234,P=0.040.There was significant difference between the two groups.The incidence of subcutaneous emphysema or pneumoperitoneum was 8.89%in the ESD group,and 12.20%in the STER group,χ~2=0.250,P=0.617.There was no significant difference between the two groups.5.The total resection rate and curative resection rate:The total resection rate was 95.56%in the ESD group,and 95.12%in the STER group,χ~2=0.009,P=0.924.There was no significant difference between the two groups.The curative resection rate was 88.89%in the ESD group,and 87.80%in the STER group,χ~2=0.009,P=0.924.There was no significant difference between the two groups.6.Metal titanium clips:In the ESD group,there were 3~12 number metal titanium clips,with an average of(4.95±2.26)number,while the STER group was used 2~11 number metal titanium clips,averaging(4.69±2.38)number,t=0.480,P=0.633.There was no significant difference between the two groups.7.The operation time:In the ESD group,the operative time was 20~200min,with the median time of operation 60 min,and the operative time in the STER group was 20~150 min,with the median time of operation 60min,Z=0.000,P=1.000.There was no significant difference between the two groups.8.The time of hospitalization and cost of operation:In the ESD group,the hospital stays was 4~11 days,with the average of hospitalization time(7.10±1.72)days,and the hospitalization time in the STER group was 4~10days,with the average hospitalization time(6.39±1.55)days,t=1.939,P=0.056,There was no significant difference between the two groups.In the ESD group,the cost of operation was 4468~5206 yuan,with the average operation cost(4839.15±167.12)yuan,and the operative cost of the STER group was 4472.47~5211.21 yuan,with the average operative cost(4843.99±167.29)yuan,t=0.129,P=0.897,and the difference was not statistically significant.9.Ultrasound endoscopy and pathological results:The results of preoperative endoscopic ultrasonography were as follows:42 cases of submucosal tumors,accounting for 48.8%;30 cases of leiomyoma,accounting for 34.9%;3 cases of lipoma,accounting for 3.5%;3 cases of cyst,accounting for 3.5%;6 cases of hemangioma,accounting for 7.0%;2 cases of Neuroendocrine tumors,accounting for 2.3%.12 cases of submucosal tumors originated from the mucosal muscular layer,45 cases from the submucosa,29cases from the muscularis propria.The results of postoperative pathological examination were as follows:47 cases of stromal tumors,accounting for54.7%;29 cases of leiomyoma,accounting for 33.7%;2 cases of lipoma,accounting for 2.3%;2 cases of cyst,accounting for 2.3%;3 cases of hemangioma,accounting for 3.5%;3 cases of neuroendocrine tumors,accounting for 3.5%.4 cases of submucosal tumors originated from the muscularis mucosa,51 cases from the submucosa,31 cases from the muscularis propria.Through statistics,the coincidence rate of endoscopic ultrasonography diagnosis and postoperative pathology diagnosis was67.44%;the coincidence rate of ultrasound endoscopy to determine the level of submucosal tumor histopathology and postoperative diagnosis was84.88%.10.Residual rate and relapse rate:In the ESD group,2 cases were residual,residual rate was 4.44%,and 1 case be left over in the STER group,residual rate 2.44%,χ~2=0.000,P=1.000.There was no significant difference between the two groups.Patients were follow-up by gastroscope in 1 month,3 months and 6 months after the operation.It showed that the wounds recovered well in both groups,no tumor recurrence,no gastrointestinal stenosis and digestive tract fistula formation.Conclusions1.Ultrasound endoscopy is an important examination before using minimally invasive surgery in the digestive tract submucosal,which can provide an important reference for the choice of surgical approach.2.Endoscopic submucosal tumor resection and endoscopic submucosal dissection are different methods for the treatment of upper gastrointestinal submucosal tumors,and they are safe and effective,with a higher rate of total resection,which can provide complete pathological data.Compared with endoscopic submucosal dissection,endoscopic submucosal tumor resection is superior with relatively smaller wound,lower incidence of perforation,and beneficial to maintain the integrity of the digestive tract.Thus endoscopic submucosal tumor resection is a new type of safe and effective minimally invasive treatment,which is worthy of clinical application. |
PDF Full Text Request