内镜黏膜下剥离术治疗消化道黏膜下肿瘤43例分析  

Endoscopic submucosal dissection for treatment of gastrointestinal submucosal tumors: 43 cases analysis

作　　者：任春蓉[1] 孙晓滨[1] 史维[1] 奚维东[1] 赵聪[1] 王琼[1] 袁德强[1] 唐宇[1] 

机构地区：[1]成都市第三人民医院消化内科,四川成都610031

出　　处：《实用医院临床杂志》2015年第5期172-174,共3页Practical Journal of Clinical Medicine

摘　　要：目的探讨内镜黏膜下剥离术（endoscopic submucosal dissection,ESD）完整切除消化道黏膜下肿瘤（submucosal tumor,SMT）的可靠性及安全性。方法 43例SMT患者行ESD,统计病灶一次性完整切除率,观察术中穿孔及术后出血情况,评价病灶组织学治愈率。结果 43例患者中,29例（67.44%）一次完整剥离成功,14例改用腹腔镜完整切除病灶。术中穿孔11例（25.58%）,包括1例胃粘膜下层颗粒细胞瘤,10例固有肌层来源的间质瘤。10例行胃壁全层切除,1例剥离病变后采用APC处理创面时发生穿孔。3例因内镜下创面封闭困难行腹腔镜修补术,8例经胃镜下金属夹成功缝合创面。33例术后随访1~3年,均未复发。结论 ESD技术的发展使深层消化道SMT的内镜完整切除成为可能,并可提供完整的病理诊断,其创伤小、恢复快、并发症发生率低,能维持正常生理解剖结构,可使该类患者免于剖腹手术。Objective To evaluate the safety and reliability of endoscopic submucosal dissection（ESD）for complete resection of gastrointestinal submucosal tumors（SMT）. Methods Forty-three patients with SMT underwent ESD. The complete resection rate, intraoperative perforation and delayed hemorrhage were statistically analyzed. The patients were followed up for evaluation of the histological cure rate. Results Of the 43 patients,29 SMT were completely resected（67.44% ） ,and 14 cases were transferred into laparoseopic resection. Intraoperative perforation happened in 11 patients（25.58% ）including 1 case with gastric submucosal granulosa cell tumor and 10 cases with interstitialoma in muscularis propria layer. Of those perforations, 10 cases were resulted from planed endoscopic full- thickness resection and 1 was due to APC treatment. Except for 3 cases transferred to laparoscopic closing, others were successfully closed under endoscopy followed by gastrointestinal decompression and antibiotics treatment. Thirty-three patients were followed-up for 1 to 3 years and no recurrence was found. Conclusion ESD is an effective and safe treatment of gastrointestinal submucosal tumors. This technique is able to resect the deep gastrointestinal lesions and provide precise pathological information about the lesion. The minimal invasiveness, rapid recovery time and low complication rate of this technique provide another choice for SMT patients to avoid from invasive surgery.

关 键 词：内镜黏膜下剥离术 消化道黏膜下肿瘤 超声内镜 

分 类 号：R735.2[医药卫生—肿瘤]