内镜套扎术切除胃黏膜下肿物的临床疗效观察

Clinical observation on curative effect of endoscopic ligation for gastric submucosal tumors

摘要:

目的 探索内镜套扎术在胃黏膜下肿物（直径≤1 cm）治疗中的有效性及安全性。方法 回顾性分析该院2020年10月－2022年7月接受内镜下治疗的177例胃黏膜下肿物患者的临床资料。根据不同内镜治疗方式，分为：内镜黏膜下剥离术（ESD）组（n = 142）和内镜套扎术组（n = 35），比较两组患者手术时间、术中并发症、术后住院时间、手术费用、病灶完整切除情况、术后并发症和病理等情况。结果 ESD组手术时间（33.23±8.55）min，明显长于内镜套扎术组的（24.85±5.96）min，术中出血均为ERB-c1级，无ERB-c2级，优于内镜套扎术组，手术费用（24 615.08±5 678.32）元，明显多于内镜套扎术组的（21 319.26±7 235.95）元，差异均有统计学意义（P < 0.05）。两组患者术中穿孔率、术后住院时间和术后随访时间比较，差异均无统计学意义（P > 0.05）。两组患者术后均未出现中转外科手术、严重感染、迟发性出血和围手术期死亡，无肿瘤复发、转移和死亡。结论 内镜套扎术具有相对安全、高效、出血量少和费用低等优点，但存在难以预判的出血风险。临床需在充分评估后，选择合适的治疗方式。

Abstract:

Objective To explore the efficacy and safety of endoscopic ligation in treatment of gastric submucosal tumors (diameter ≤ 1 cm).Methods Clinical data of 177 patients with gastric submucosal tumors who received endoscopic therapy from October 2020 to July 2022 were retrospectively analyzed. Patients were divided into endoscopic submucosal dissection (ESD) group (n = 142) and endoscopic ligation group (n = 35) according to different endoscopic treatment methods, and the operation time, intraoperative complications, postoperative hospital stay, surgical cost, complete lesion resection, postoperative complications and pathology of the two groups were compared.Results The operative time of the ESD group was (33.23 ± 8.55) min, which was significantly longer than that of the endoscopic ligation group (24.85 ± 5.96) min. The intraoperative bleeding was ERB-c1 and no ERB-c2 of the ESD group, which was better than that of the endoscopic ligation group, and the operative cost was (24 615.08 ± 5 678.32) yuan, significantly more than that of the endoscopic ligation group (21 319.26 ± 7 235.95) yuan, the differences were statistically significant (P < 0.05). There was no significant difference in the intraoperative perforation rate, postoperative hospitalization time and postoperative follow-up time between the two groups (P > 0.05). No surgical transfer, serious infection, delayed hemorrhage and perioperative death occurred in both groups, and no tumor recurrence, metastasis and death were found.Conclusion Endoscopic ligation has the advantages of relatively safe, efficient, less blood loss and low cost, but it has the risk of bleeding which is difficult to predict. Therefore, it is particularly important to select appropriate treatment after adequate evaluation.