内镜黏膜下剥离术及全层切除术治疗 胃黏膜下肿瘤的临床疗效分析

Clinical effects analysis of endoscopic submucosal dissection and endoscopic full-thickness resection for gastric submucosal tumors

摘要:

目的 评价内镜黏膜下剥离术及全层切除术治疗胃黏膜下肿瘤的安全性和有效性。方法 168例胃黏膜下肿瘤患者行内镜粘膜下剥离术（ESD）或全层切除术（EFR），手术操作分为标记、抬起、切缘、剥离和（或）切除及创面处理5步，评价操作成功率、治疗成功率和并发症发生率。结果 140例起源于黏膜下层胃黏膜下肿瘤行ESD术，均完整剥离病变，病灶直径为1.2～3.0 cm，平均手术时间为（25.0±3.5）min（15～60）。病理诊断为间质瘤86例、平滑肌瘤45例、脂肪瘤4例和神经鞘瘤5例。术后无出血及穿孔发生。28例起源于固有肌层及固有肌层与浆膜紧密粘连的胃黏膜下肿瘤，行EFR术成功切除包括浆膜在内的所有病变，平均手术时间为（75.0±10.5）min（45～140），切除肿瘤直径1.8～4.0 cm，病理诊断为间质瘤16例、异位胰腺4例、平滑肌瘤7例和神经鞘瘤1例。术后无胃肠道出血，1例术后2周因夹闭创面钛夹脱落出现腹膜炎体征，行内镜下修补夹闭创面，3 d后症状消失。所有病例均未行外科手术治疗，平均住院天数（5.0±2.0）d（3～10）。中位随访时间为7.5个月，无复发。结论 ESD及EFR治疗胃黏膜下肿瘤安全有效，可替代外科手术，值得应用推广。

Abstract:

【Objective】 To assess the safety and the efficacy of endoscopic submucosal dissection(ESD)and endoscopic full-thickness resection(EFR)for gastric submucosal tumors. 【Methods】 A total of 168 patients with SMT were operated by ESD or EFR. Operation consisted of five major procedures, including marking, injection to elevate the 1esion, pre-cutting, dissecting or resection, wound processing. The technical success rate, treatment success rate, complication occurring rate were evaluated. 【Results】 140 cases arising from submucosal were successfully treated with ESD, the mean operation time was (25.0±3.5) min (15~60 min). The mean tumor size was 2.0 cm (1.2~3.0cm). Immunohistostaining demonstrated gastrointestinal stromal tumors (GIST) in 86 cases, leiomyoma in 45, lipomyoma in 4 and Schwannoma in 5 patients. No gastric bleeding, peritonitis or abdominal abscess occurred after ESD. 28 cases arising from the muscularis propria were successfully treated with EFR, the mean operation time was (75.0±10.5) min (45~140 min). The mean tumor size was 2.6 cm (1.8~4.0 cm). Immunohistostaining demonstrated GIST in 16 cases,heterotopic pancreas in 4, leiomyoma in 7 and Schwannoma in 1 patient. No gastric bleeding occurred after EFR, one case was complicated by perforation after 2 week, and the perforations were closed with metal clips. The mean hospitalization time was (5.0±2.0) d (3~10 days). The mean follow-up period was 7.5 months (1~12 months) with no lesion residue or recurrence. 【Conclusion】 Gastric submucosal tumors can be treated successfully with ESD and EFR, which could replace certain surgical operations and should be considered for further application.