超声内镜指导内镜套扎治疗消化道黏膜下肿瘤的研究  

Endoscopic Ligation Therapy for Upper Gastrointestinal Submucosal Tumor under Endoscopic Ultrasound Guidance

作　　者：陈斌[1,2] 陈白莉[1] 吴晖[3] 崔毅[1] 

机构地区：[1]中山大学第一附属医院消化科 [2]广州中医药大学第一附属医院脾胃病科 [3]中山大学第一附属医院胃肠外科,广东广州510080

出　　处：《中山大学学报（医学科学版）》2013年第2期235-239,共5页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：2010年国家自然基金青年基金项目(81001506)

摘　　要：【目的】探讨超声内镜辅助下橡皮圈或尼龙绳套扎术治疗消化道黏膜下肿瘤的适应症、近期疗效及并发症。【方法】经普通胃镜及超声内镜检查,诊断为食管、胃黏膜下肿瘤58例,均拟诊为上消化道间质瘤或平滑肌瘤。所有病变均采用标准橡皮圈或尼龙绳套扎法治疗,术后常规口服质子泵抑制剂(PPI)并于术后两周复查胃镜。【结果】肿瘤直径0.5～4.0 cm,平均1.2(S=0.5)cm,病变位于食道26(44.8%)例,胃23(39.7%)例,十二指肠9(15.5%)例;位于固有肌层28(48.3%)例,黏膜肌层24(41.4%)例,黏膜下层6(10.3%)例。一次套扎成功53例(91.4%),失败5例(8.6%),其中4例为2周后复查发现病变残留,其直径>1.5 cm(1.5～4.0 cm)且位于固有肌层,1例因不能耐受手术中途放弃套扎。结果表明病变大小、层次及生长方式是套扎成功的决定因素。3例患者术后5天内出现一过性少量黑便,未经特殊处理症状消失,无穿孔、大出血等严重并发症发生。【结论】超声内镜辅助下橡皮圈或尼龙绳套扎术治疗直径<1.5 cm的上消化道粘膜下肿瘤安全有效,可行性好。[ Objective ] The safety and efficacy of endoscopic ultrasonography （EUS） assistant elastic band or endoloop ligation methods, for the resection of upper gastrointestinal stromal tumor （GIST） , was evaluated. [Methods] The study included totally 58 patients with upper gastrointestinal stromal tumor which were determined by endoscopy and EUS. The standard procedure of endoscopic elastic band or endoloop ligation was performed for each of the patient. The entire patients received PPI treatment for 2 weeks and were followed up with endoscopy after 2 weeks. [Results] The lesion diameters of the 58 recruited patients were 0.5-4.0 cm （1.2±0.5）cm. They distribution in esophagus （44.8%）, stomach （39.7%） duodenal （15.5%） and located in muscularis propria （48.3%）, muscularis mucosae （41.4%）, submucosa （10.3%）, respectively; 53 （91.4%） out of them were sloughed completely. Four resulted in unsuccessful resection with the diameter larger than 1.5 cm （1.5-4.0 era） and all located in muscularis propria, 1 （1.7%） quitted from the procedure because of intolerance. Statistics showed that the decisive factors for successful treatment were the sizes, layer of invasion and feature of growth. Transient bleeding occurred in 3 patients within 5 days after ligation and disappeared without special management. No perforation and other complications occurred. [ Conclusion] Compared with conventional surgical operation, tumor size selective （〈1.5 cm） EUS assistant endoscopic elastic band or endoloop ligation method is a safe, less suffering and less invasive method for the therapy of GIST in upper Gastrointestinal tract.

关 键 词：消化道 粘膜下肿瘤 套扎术 超声内镜 

分 类 号：R735[医药卫生—肿瘤]