内镜下纵切挖除术治疗消化道黏膜下肿瘤患者  

The clinical value of endoscopic longitudinal incision and excavation for gastrointestinal submucosal tumors

作　　者：宋健[1] 董文珠[1] 王群英[1] 张花莲 杨杰[1] 姚萍[1] 钟慧闽[1] 

机构地区：[1]解放军第401医院消化科,青岛266071

出　　处：《中华消化病与影像杂志（电子版）》2011年第1期22-24,共3页Chinese Journal of Digestion and Medical Imageology(Electronic Edition)

摘　　要：目的探讨内镜纵切挖除术（ELE）治疗消化道黏膜下肿瘤（SMT）的疗效和可行性。方法对2011年2月至7月经辅助检查和前期治疗明确诊断为起源于消化道的SMT患者19例，在清醒镇静下行ELE治疗：（1）黏膜下注射生理盐水，纵行切开肿瘤表面黏膜和黏膜下层，显露肿瘤。（2）采用内镜黏膜下剥离术沿肿瘤周围分离至肿瘤基底部。（3）胃镜直视下应用Hook刀、IT刀或圈套器完整切除肿瘤。（4）应用金属夹缝合手术创面。结果19例消化道SMT患者中，病灶位于食道3例、贲132例、胃底3例、胃体5例、胃窦5例、升结肠1例。ELE成功切除所有病变，完整切除率为100．0％；ELE时间为25～125min，平均45min。切除肿瘤直径范围1．5-3．5cm，平均2．0cm；病理诊断为平滑肌瘤11例、脂肪瘤5例、间质瘤3例。术后无一例出现出血及腹膜炎体征。住院时间7。15d，平均10d。术后随访1～3个月，平均2个月，无一例病变残留。结论ELE治疗消化道SMT患者是安全有效的，手术方法较内镜黏膜下剥离术简便，便于缩短手术时间及术后并发症的防治，并且有利于术后创面的愈合。Objective To evaluate the feasibility and efficacy of endoscopic longitudinal incision and excavation （ELE） for gastrointestinal submucosal tumors （SMTs）. Methods A total of 19 cases of gastrointestinal submucosal tumors （SMTs） was resected by ELE from February 2011 to July 2011 in conscious sedation.ELE consisted of five major procedures,including normal saline injection into the submucosa and longitudinal incision of the mucosal and submucosal along the surface of the lesion, circumferential incision as deep as muscularis propria around the lesion and to its base with endoscopic submucosal dissection （ESD）,excavation of the lesion with a Hook knife, IT, or snare and closure of the incision with metallic clips. Results Of 19 gastrointestinal SMTs,3 located at the esophagus, 2 at the cardia, 3 located at the fundus, 5 at the gastric body, 5 at the antrum, 1 at the ascending colon.ELE was successfully performed in all 19 patients.The complete resection rate was 100% ,and the mean operation time was 75 min （25-125 min）.The mean tumor size was 2.0cm （1.5-3.5） cm.Pathological examination confirmed Leiomyoma in 3 cases, lipoma in 5, gastrointestinal stromal tumors （GISTs） in 3 patients.No gastrointestinal bleeding, peritonitis or abdominal abscess occurred after ELE.The mean hospitalization time was 10d （7-15d）.The mean follow-up period was 2 months （1-3 months）with no lesion residue. Conclusion ELE was efficacious, safe, and minimally invasive for patients with gastrointestinal SMTs. It can shorten the operation time and the wound cure time after operation, and be easy to prevent operation complication.

关 键 词：内窥镜手术 消化道 粘膜下肿瘤 内镜下纵切挖除术 

分 类 号：R735[医药卫生—肿瘤]