圈套器预切开后内镜黏膜切除术治疗食管黏膜下良性肿瘤的临床观察

目的 评估圈套器预切开后再行内镜黏膜切除术（endoscopic mucosal resection，EMR）治疗食管黏膜下良性肿瘤的临床效果及安全性。方法 2016年1月—2018年12月，苏州市第九人民医院消化内镜中心86例行EMR治疗的食管黏膜下良性肿瘤病例纳入回顾性分析,其中采用圈套器环周预切开后EMR治疗的45例纳入观察组，采用传统EMR治疗的41例纳入对照组，主要比较两种方法的手术时间、一次性完整切除率、并发症发生率。结果 手术时间观察组为（10.20±2.42）min，对照组为（10.46±4.02）min（t=0.11，P=0.93）；一次性完整切除率观察组为100.0%（45/45），对照组为87.8%（36/41）（χ2=5.830， P=0.02）。2组均未发生术后出血、发热、穿孔、狭窄，观察组发生术后胸痛2例（4.4%，2/45），对照组发生术后胸痛2例（4.9%，2/41）（χ2=0.001， P=0.99）。结论 圈套器预切开后EMR治疗食管黏膜下良性肿瘤安全有效，在一次性切除方面较传统EMR更具优势。

The evaluation of pre-cut-endoscopic mucosal resection intreatment of esophageal benignsubmucosal tumors

Objective To evaluate the effect of pre-cut-endoscopic mucosa resection of esophageal submucosal tumors. Methods 86 patients with esophageal submucosal tumors were enrolled from January 2016 to December 2018 who were detected by upper endoscopy and the tumor(maximum diameter <2.0cm)has been confirmed in muscularismucosaor submucosa by EUS.Thepatientswere randomly divided into two groups,45 patients were treated by pre-cut-endoscopic mucosal resection(observation group),and the other 41 patients were treated by conventionalendoscopic mucosal resection. The total resection of tumor was assessed after procedure and evaluate the healing of focus byupper endoscopy after 3 months .The clinical results includingprocedure time, all bloc resection rate,complication and recurrence rates were retrospectively evaluated.Results All the cases were successfully treated by endoscopicStreatment, the histopathological diagnoses of esophageal submucosal tumors included 79 liomyoma, 5 lipoma and 2 GISTs. In observation group,the all enbloc resection was achieved in 45 patients (100.0 %) with a mean operation time of (10.20 ± 2.42) min, and there were no such severe complications as bleeding and perforationhappening during and after operation.Incontrol group,theall bloc resection rate was 87.8% with a mean operation time of (10.46 ± 4.02) min, and 5Sunsuccessful operation were received additional ESD. The difference of all bloc resection rate between two groups have a statisticssignificance(P<0.05).Conclusion Pre-cut-endoscopic mucosal resection was an effective and safe therapy for esophageal submucosal tumors,and It has moreSobviousSadvantageSin all enblocresection,mean operation time and safety than conventionalendoscopic mucosal resection.