体位管理在内镜下胃肿瘤全层切除术中的影响

Patient position: a critical variable for planning endoscopic full-thickness resection of gastric tumors

摘要:

目的 分析术中体位管理对胃黏膜下巨大肿瘤患者在内镜下全层切除术（EFTR）中的影响。方法 回顾性分析2017年12月－2019年7月在该院消化内科被诊断为胃黏膜下巨大肿瘤（肿瘤直径 ≥ 2.0 cm）并接受EFTR的患者。术中调整患者体位以避免肿瘤被胃腔内液体淹没，并分析患者的术中体位与肿瘤位置的关系以及对EFTR术后效果的影响。结果 共37例患者纳入研究，术中体位包括：左侧卧位、仰卧位、俯卧位和右侧卧位。根据肿瘤的位置，采取对应的术中体位使肿瘤处于高位，术中视野暴露良好，镜下止血、缝合以及其他操作不受胃腔内液体的影响。所有患者均成功实施EFTR，未见大出血、肿瘤掉入腹腔、显性腹膜炎征象。结论 EFTR治疗胃黏膜下巨大肿瘤时，使肿瘤处于高位的术中体位管理应受到重视。通过术前CT确认肿瘤位置或内镜下注水后观察手术视野，均可为患者体位的选择提供依据。该体位管理简单易行，不增加医疗费用，具有降低内镜下操作难度、增加手术安全性和缩短手术时间的优势。

Abstract:

Objective To analyze the effect of patient position on the results of endoscopic full-thickness resection procedures of large submucosal gastric tumors.Methods This is a retrospective study in which consecutive patients with large ( ≥ 2.0 cm) gastric submucosal tumors who underwent endoscopic full-thickness resection from December 2017 to July 2019 were included. During the procedure the patient’s position was changed to maintain the tumor from being submerged under gastric fluids. The relationship between tumor location and patient's position required for successful endoscopic full-thickness resection procedure were analyzed.Results 37 patients were included in this study. The position during the operation included left lateral position, supine position, prone position and right lateral position. The intraoperative position was adopted to keep the tumor in a high position according to the location of the tumor. The operative field was well exposed and the endoscopic operations were not affected by the liquid in the gastric cavity. All these patients underwent successful endoscopic full-thickness resection. No tumor fell into the peritoneal cavity, no overt peritonitis and massive bleeding occurred in any patient.Conclusion Intraoperative postural management to keep the tumor in high position should be considered before and during endoscopic full-thickness resection of large submucosal gastric tumors. A preoperative CT scan or the observation after water injection under endoscope is especially useful to provide crucial information for choosing the patient position. This position management is simple and does not increase the hospitalization cost. It has the advantages of reducing the difficulty of endoscopic operation, increasing the safety of operation and shortening the operation time.