内镜下结扎剥离术在切除胃固有肌层来源小肿瘤中的应用价值初探  

Ligation-assisted endoscopic dissection： a novel technique for resection of small gastric tumors originating from muscularis propria

作　　者：郭瑾陶[1] 刘治军[1] 潘珅[1] 孙思予[1] 王晟[1] 刘香[1] 葛楠[1] 王国鑫[1] 杨向红[2] 

机构地区：[1]中国医科大学附属盛京医院内镜诊治中心,沈阳110004 [2]中国医科大学附属盛京医院病理科,沈阳110004

出　　处：《中华消化内镜杂志》2011年第10期549-554,共6页Chinese Journal of Digestive Endoscopy

摘　　要：目的初步探讨内镜下结扎剥离技术治疗胃固有肌层来源小肿瘤的有效性和安全性。方法对33例患有胃固有肌层来源1cm以下肿瘤的患者进行内镜下结扎剥离治疗。用皮圈结扎瘤体，之后用钩刀或IT刀对瘤体进行剥离，直到瘤体完全或部分剥离出来，标本送组织学检查，创面以金属夹和医用胶封闭。分别于术后1周、1个月、3个月、6个月、12个月进行内镜检查观察瘤体脱落情况及创面愈合情况。结果33个病例中，25个瘤体内镜下部分剥离，8个瘤体内镜下完整剥离，33个瘤体均随着皮圈套完整脱落，所有病例均获得了确切的病理学诊断。1例患者出现自限性的出血，未出现穿孔等并发症。术后随访3—18个月，无复发患者。结论内镜下结扎剥离是治疗胃固有肌层来源肿瘤安全、有效，而且相对简单的技术，优势在于为病变提供了组织病理学诊断。Objective To evaluate the efficacy and safety of ligation-assisted endoscopic dissection （ED-L） technique for the removal of gastric tumors originating from muscularis propria. Methods A total of 33 patients with gastric tumors originating from muscularis propria less than 10 mm were treated with ED-L procedures. The tumor was ligated by elastic hands. Endoscopic dissection was performed until the tumor was partially or completely dissected from muscularis propria by using Hook knife and/or IT-knife. The wound was closed with metallic clips and medical adhesive. The patients were followed up 1 week, 1 month, 3 months, 6 months and 12 mouths thereafter with endoscopy, respectively. Results Of the 33 gastric tumors, there were 25 partial dissections and 8 complete dissections. All of the tumors sloughed completely. Pathological diagnoses of all the patients were acquired. No complications like perforation occurred except for one self-limiting and non-life-threatening hemorrhage. There was no recurrent case during the 3-18 months of follow-up period. Conclusion ED-L is a safe, effective and relatively simple technique for excision of small gastrointestinal tumors originating from muscularis propria, providing a histopathological diagnosis as well.

关 键 词：胃 内窥镜超声检查术 固有肌层来源肿瘤 结扎剥离 

分 类 号：R735.2[医药卫生—肿瘤]