内镜下切除胃底固有肌层肿瘤的临床价值研究  

Therapeutic value of endoscopic resection of tumors originated from gastric fundus muscularis propria

作　　者：许秋泳[1] 陈俊杰[1] 赖亚栋[1] 蒲惠 刘麒英 林淑惠[1] 陈雪芬[1] 许向农[1] 

机构地区：[1]福建医科大学附属漳州市医院消化内科,漳州363000

出　　处：《中华消化内镜杂志》2015年第3期175-179,共5页Chinese Journal of Digestive Endoscopy

摘　　要：目的：探讨胃底固有肌层肿瘤内镜下切除治疗的疗效及安全性。方法回顾性分析2012年1月至2014年6月对内镜超声发现的源于胃底固有肌层的黏膜下肿瘤行内镜下切除的53例患者资料，评价内镜下切除治疗的手术过程及术后风险。结果53例患者均顺利完成内镜下切除治疗，病变直径为0.5～4.5 cm，均一次性完整切除病变，手术时间25～155 min，平均（46.7±18.2）min。术中创面均有不同程度出血，出血量为 5～150 ml，经氩离子凝固术、热活检钳凝固术或金属夹闭合创面止血成功。有8例术中并发穿孔（8／53），7例应用钛夹夹闭或尼龙圈联合钛夹缝合穿孔成功，另1例穿孔直径过大，转腹腔镜腔外缝合，术后给予胃肠减压、质子泵抑制剂抑酸、抗炎等治疗，均无术后出血。内镜下切除术后住院3～14 d，平均（5.3±1.4）d，穿孔患者术后1个月胃镜复查见穿孔均闭合。术后病理诊断46例为间质瘤，7例为平滑肌瘤。所有患者接受随访3～27个月，未见病变残留和复发。结论内镜下切除术不仅符合了胃底局部完整切除固有肌层肿瘤的治疗原则，而且还可获得完整病理结果，是一种安全、有效、值得推广的方法。Objective To investigate the safety and effectiveness of endoscopic resection of tumors originated from gastric fundus muscularis propria.Methods Data of 53 patients with tumors originated from gastric fundus muscularis propria detected by endoscopic ultrasonograpy,treated by endoscopic resection and followed up at our hospital between January 2012 and June 2014 were reviewed.The postoperative pathology and complications were retrospectively analyzed to evaluate the therapeutic effect and safety.Results The procedure was successfully performed on all patients and all lesions were removed in one procedure.The lesion size ranged from 0.5 to 4.5 cm and the operation time was 25-155 min[mean（46.7 ±18.2）min].Mild bleeding （5 ~150 ml）occurred in all cases,which was successfully managed by argon plasma coagulation,hot biopsy probe or endoclip.Perforation occurred in 8 patients（8 /53）,seven of whom were closed with titanium clips and titanium clips combined with nylon cord.Laparoscopic intervention was applied to 1 case because of severe perforation.Gastrointestinal decompression,acid suppression with proton pump inhibitors and antibiotics were performed on all cases.No severe hemorrhage occurred.The average length of hospitalization was （5.3 ± 1.4）days（3-14 d）.Pathology confirmed 46 cases of gastrointestinal stromal tumors and 7 cases of leiomyoma. The patients were followed up for 3 to 27 months,and no tumor residue or recurrence was observed. Conclusion Endoscopic resection is a method not only to get the accurate pathologic diagnosis but also to meet principle of the local resection for stomach.It is safe,effective and worthy of recommendation.

关 键 词：胃底 固有肌层肿瘤 内镜切除 内镜超声 ENDOSCOPIC ultra- 

分 类 号：R735.2[医药卫生—肿瘤]