内镜下透明帽辅助尼龙绳结扎术在胃底黏膜下肿瘤治疗中的应用

Clinical application of cap-assisted endoscopic nylon loop ligation (C-ENLL) on gastric fundus submucosal tumors

摘要:

：目的 评估内镜下透明帽辅助尼龙绳结扎术（C-ENLL）作为一种新而简单的方法治疗胃底 黏膜下肿瘤（SMT）的可行性及安全性。方法 回顾性研究2015 年1 月-2016 年6 月在该院超声胃镜提 示直径≤ 2.00 cm 的胃底SMT 患者74 例。所有患者均经C-ENLL 治疗，观察其临床疗效及进行统计分析。 结果 74 例患者术前均行超声内镜检查，70 例来源于固有肌层，3 例来源于黏膜肌层，1 例来源于黏膜下层， 病变平均直径0.50 ～ 1.80 cm。所有患者均成功顺利切除病灶，操作时间18 ～ 45 min，平均26 min。2 例发 生迟发性穿孔，予以尼龙绳及金属夹荷包缝合创面，留置胃肠减压，内科保守治疗成功。术后均无迟发性出血。 术后病理诊断：间质瘤49 例（66.2%），平滑肌瘤20 例（27.0%），炎性纤维瘤5 例（6.8%）。患者接受随访3 ～ 12 个月，未见病灶残留和复发。结论 内镜下带槽透明帽辅助尼龙绳结扎术是治疗直径较小的胃底SMT 的一种可行有效、费用低的方法。

Abstract:

Objective To evaluate the feasibility and safety of cap-assisted endoscopic nylon loop ligation (C-ENLL) as a new and simple method on gastric fundus submucosal tumors. Methods 74 cases with small gastric fundus submucosal tumors ≤2.00 cm in diameter were reviewed between January 2015 and June 2016. All cases were treated by C-ENLL. The clinical efficacy was analyzed. Results All the 74 patients underwent endoscopic ultrasonography before operation, 70 cases originated from the muscularis propria, 3 cases originated from the muscularis mucosae, 1 case originated from the submucosa. The average diameter of the lesions ranged 0.50 ~ 1.80 cm. C-ENLL achieved an en bloc resection rate of 100.0%, with a mean total procedure time of 26 min. Two patients developed delayed perforation, were treated with nylon rope and metal clip purse suture wound. All of whom were managed successfully. There was no delayed bleeding after operation. Pathological examination showed that 66.2% (49/74) of the tumors were gastrointestinal stromal tumors. No tumor recurrence was observed during the follow-up. Conclusion The C-ENLL may be a feasible and safe method for the treatment of small gastric fundus submucosal tumors.