目的：比较隧道式黏膜剥离术（ESTD）与常规黏膜剥离术（ESD）治疗食管大面积浅表性肿瘤手术效率和安全性。方法回顾性分析2010年10月~2013年6月于我院消化内镜中心行食管肿瘤内镜下切除治疗235例患者的临床资料。按照纳入和排除标准，筛选接受ESTD或ESD治疗的食管大面积浅表性肿瘤患者，分析其临床资料。结果共29例患者纳入研究，平均年龄62岁（49~78岁），男16例，女13例，手术平均时间81.3 min（34~239 min）。其中ESTD组11例，ESD组18例。两组比较，ESTD组剥离速度明显快于ESD组（22.4±5.2 mm2/min vs 12.2±4.0 mm2/min，P<0.05）。虽然两组整块切除率差异不明显[100%（11/11） vs 83.3%（15/18），P>0.05]，但在根治性切除率方面，ESTD明显高于ESD组[81.8%（9/11）vs 66.7%（12/18），P<0.05]。ESD组有1例出现术中出血，而ESTD组均无出血、穿孔及纵膈气肿发生。术后8例发生食管狭窄，其发生率同病变环周程度和长度有关（P<0.05）。结论ESTD不仅能安全有效地完成食管大面积的表浅性肿瘤的切除，而且同ESD相比，手术时间短，剥离速度快，肿瘤根治性切除率高。但是，对于食管环周超过3/4或长度超过50 mm的病变，应注意防治术后食管狭窄的发生。%Objective To compare the safety and efficiency of endoscopic submucosal tunnel dissection (ESTD) and endoscopic submucosal dissection (ESD) for large esophageal superficial neoplasms. Methods A total of 235 consecutive patients undergoing endoscopic resection for esophageal neoplasms between October, 2010 and June, 2013 in our endoscopy center were analyzed retrospectively. According to the inclusion and exclusion criteria, 29 patients receiving ESTD or ESD for large esophageal superficial neoplasms were enrolled for data analysis. Results Of the 29 patients, 11 underwent ESTD and 18 received ESD. The dissection speed of ESTD was significantly higher than that of ESD (22.4±5.2 mm2/min vs 12.2±4.0 mm2/min, P<0.05). Despite a similar en bloc rate between the two groups (100%[11/11]vs 88.9%[16/18], P>0.05), the radical curative rate of ESTD was significantly greater than that of ESD (81.8%[9/11]vs 66.7%[12/18], P<0.05). No serious bleeding or perforation occurred in the patients except for 1 in ESD group with intraoperative bleeding, which was managed with hemostatic forceps. Eight patients had postoperative esophageal strictures in relation with circumferential extension and the longitudinal length (P<0.05). Conclusions ESTD is a safe and effective alternative for large esophageal superficial neoplasms with a shortened operative time, a higher dissection speed and a higher radical curative rate in comparison with ESD, but postoperative esophageal strictures should be closely monitored especially for lesions more than 3/4 of the circumferential extension or exceeding 50 mm.
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