内镜经黏膜下隧道肿瘤切除术在胃固有肌层肿瘤中的应用与评价  

Application and evaluation of submucosal tunneling endoscopic resection of gastric submucosaltumors originating from the muscularis propria layer

作　　者：徐美东[1] 陆巍[1] 李全林[1] 周平红[1] 钟芸诗[1] 陈巍峰[1] 张轶群[1] 姚礼庆[1] 

机构地区：[1]复旦大学附属中山医院内镜中心复旦大学内镜诊疗研究所,上海200032

出　　处：《中华胃肠外科杂志》2012年第7期671-674,共4页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基上海市科委重大科研计划项目（09DZl950102）

摘　　要：目的评价内镜经黏膜下隧道肿瘤切除术（STER）治疗来源于固有肌层的胃黏膜下肿瘤（SMT）的临床应用价值。方法回顾性分析2010年9月至2011年12月间在复旦大学附属中山医院内镜中心接受STER术的23例来源于固有肌层的胃SMT患者的临床病理资料。结果男性13例。女性10例，年龄28-73（平均52．4）岁。23例胃SMT中贲门近胃体侧11例，贲门近胃底侧4例，胃体小弯5例，胃窦大弯侧3例。来源于固有肌层浅层14例，深层9例，其中5例与浆膜层粘连，密不可分。23例STER手术均获成功，所有SMT均完整切除。切除病变直径1．5-3．2（平均2．1）cm：肿瘤切除至黏膜切口完整缝合时间30-125（平均54．8）min。术后病理诊断：平滑肌瘤10例，胃肠间质瘤8例，血管球瘤2例，神经鞘膜瘤2例，钙化性纤维性肿瘤1例；切缘均为阴性。发生气胸伴皮下气肿3例次，气腹5例次，左侧膈下积液伴继发感染1例次，均予保守治疗痊愈。术后无迟发性消化道出血、消化道瘘、黏膜下隧道内积血积液和感染病例。随访3-18个月，无一例病变残留或复发。结论STER治疗适宜部位的胃固有肌层SMT安全、有效。能够一次性完整切除病变，提供完整的病理学诊断资料，且可以迅速恢复消化道完整性，避免消化道瘘的发生。Objective To evaluate the clinical value of submucoal tunneling endoscopic resection （STER） for gastric submucosal tumor （SMT） originating from the muscularis propria （MP） layer. Methods Clinicopathological data of 23 cases with gastric SMT originating from the MP layer treated with STER from September 2010 to December 2011 were analyzed retrospectively. Results There were 13 males and 10 females. The age ranged from 28 to 73 （mean, 52.4） years old. Of the 23 SMTs, 11 were located in the cardia adjacent to the gastric body, 4 in the cardia adjacent to the fundus, 5 in the lesser curvature of gastric body and 3 in the gastric antrum of greater curvature. All the SMTs originating from the MP layer, 14 were located in the superficial MP layer and 9 in the deep MP layer（including 5 gastric SMTs close to serosa）. En b^toc STER was performed successfully in all the patients. The mean lesion size was 2.1 cm （range 1.5-3.2 cm）. The mean procedure time was 54.8 min （range 30-125 min）. Pathological examination showed that the lesions were leiomyomas（n=10）, stromal tumors （n=8）, glomus tumor （n=2）, Sehwannoma （n=2）, and calcifying fibrous tumor （n=l）. Both lateral and vertical margins were negative in all the cases. Three patients developed pneumothorax and subcutaneous emphysema and 5 pneumoperitoneum. One patient developed effusion under the left half of the diaphragm and secondary infection. All of them recovered uneventfully after conservative treatments. No delayed bleeding or GI tract leakage was noticed. None of the 23 cases encountered submucosal hematoma or infection. No tumor residual or recurrence was found during the follow up （range, 3-18months）. Conclusions STER is a safe, effective for appropriate lesions in the MP layer of the stomach. En bloc resection and accurate histopathological evaluations can be achieved.

关 键 词：胃肿瘤 黏膜下肿瘤 固有肌层 内镜经黏膜下隧道肿瘤切除术 

分 类 号：R735.2[医药卫生—肿瘤]