经内镜胃黏膜下隆起性病变治疗方法探讨  

Investigation of endoscopic therapy of gastric submucosal eminence lesions

作　　者：张彩凤[1] 夏永华[2] 李贞娟[1] 韩宇[1] 刘竹娥[1] 王文菊[1] 李琨[1] 董良鹏[3] 

机构地区：[1]新乡医学院第一附属医院消化内科,河南卫辉453100 [2]新乡医学院第一附属医院皮肤科,河南卫辉453100 [3]新乡医学院第一附属医院普外科,河南卫辉453100

出　　处：《中国内镜杂志》2012年第7期701-705,共5页China Journal of Endoscopy

基　　金：河南省教育厅科研项目(No.20073200143)

摘　　要：目的探讨内镜下治疗胃黏膜下隆起性病变(GSEL)的疗效及并发症。方法胃镜及超声内镜(EUS)诊断的GSEL62例,≤0.5cm GSEL给予高频电凝电切除;0.5cm<GSEL≤2.0cm GSEL行内镜下黏膜切除术(EMR)、内镜黏膜下剥离套扎术;>2.0cm GSEL行EMR、内镜黏膜下剥离术(ESD)及内镜下尼龙绳结扎术。结扎后切除病变游离端部分组织及表层组织送病理学检查,将EUS的检查结果和病理对照。2周后胃镜EUS观察疗效及并发症,术后3、6、12和24个月胃镜和EUS复查。结果≤0.5cm GSEL内镜下均切除完全,术后未出现并发症。0.5cm<GSEL≤2.0cm亦完全脱落,其中1例出现穿孔。>2.0cm GSEL只有2例多次内镜下治疗后病变消失。余行内镜下治疗的患者复查胃镜及EUS均无复发。内镜和手术病理和EUS的结果完全吻合。结论经内镜治疗GSEL的疗效和病变大小有很大关系,>2.0cm GSEL治疗效果差。[ Objective ] To evaluate the clinical efficacy and complications of endoscopic treat of gastric submu- cosal eminence lesions （GSEL）, [ Methods ] 62 cases were diagnosed as GSEL by endoscopy and endoscopic ultra- sonography （EUS）. GSEL≤0.5cm were directly removed by high-frequency electrosurgery; 0.5 cm〈GSEL≤2.0 cm were treated by endoscopic mucosal resection （EMR）, endoscopic submucosal dissection （ESD） and ligation; GSEL〉 2.0 cm were treated by EMR, ESD and ligation of nylon rope. Part of the free end organization and surface tissue removed were sent to pathology after ligation, and compared with EUS. Each patient should be observed the efficacy and complications by endoscopy and EUS 2 weeks, 3 months, 6 months, 12 months and 24 months later. [Results] GSEL ≤0.5 cm was removed completely without complications. 0.5 cm ≤ GSEL ≤ 2.0 cm was completely off with 1 case perforated. There weren＇t recurrence in these patients above. However, we failed to remove GSEL 〉2.0 cm ex- cept 2 cases. There was no difference between endoscopic and surgical pathology and EUS. [ Conclusions ] Endo- scopic therapy efficacy of GSEL has a lot of its diameter, and its efficacy of GSEL 〉2.0 cm is poor.

关 键 词：胃黏膜下隆起型病变 内镜黏膜切除术 内镜黏膜下剥离术 治疗 

分 类 号：R573[医药卫生—消化系统]