胃固有肌层肿瘤内镜切除术中穿孔内镜闭合术与腹腔镜修补术的疗效比较  

Comparison between endoscopic closure and laparoscopic repair for perforation in endoscopic resection of gastric submucosal tumors originating from the muscularis propria layer

作　　者：屠惠明[1] 乔峤[1] 许科斌[1] 费伯健[2] 杨帆[1] 李捷[1] 高其中[2] TU Hui-ming;QIAO Qiao;XU Ke-bin;FEI Bo-jian;YANG Fan;LI Jie;GAO Qi-zhong(Department of Gastroenterology;Department of Endoscopic Surgery,Affiliated Hospital to Jiangnan University, Wuxi 214062, Jiangsu, China)

机构地区：[1]江南大学附属医院消化内科,江苏无锡214062 [2]江南大学附属医院腔镜外科,江苏无锡214062

出　　处：《川北医学院学报》2018年第2期169-172,共4页Journal of North Sichuan Medical College

基　　金：江苏省"六大人才高峰"资助项目(2014-WSN-068);无锡市科技局项目科技发展资金资助(CSE31N1403)

摘　　要：目的:通过胃固有肌层肿瘤内镜切除术内镜黏膜下肿物挖除术(endoscopic submucosal excavation,ESE)和内镜全层切除术(endoscopic full-thickness resection,EFR)术中治疗性穿孔,比较内镜闭合术和腹腔镜辅助闭合术疗效,探讨急性穿孔的内镜闭合术疗效和安全性。方法:选取经超声内镜(EUS)发现的起源于胃固有肌层的黏膜下肿瘤(SMTs),在内镜下切除ESE/EFR术中发生治疗性穿孔的病例40例,分为腹腔镜修补术组与内镜闭合术组,各20例。结果:ESE及EFR术后病理38例诊断为间质瘤,2例平滑肌瘤。两组在<0.5 cm穿孔手术耗时、医疗费用相比差异均有统计学意义(P<0.05);两组>0.5cm穿孔手术耗时、术后住院时间比较无显著差异(P>0.05)。全组未出现术后出血,随访5~32个月,恢复良好,未出现复发或转移。结论:内镜下肌层剥离术(endoscopic muscularis dissection,EMD)治疗上消化道固有肌层肿瘤术中穿孔内镜闭术与腹腔镜修补术比较具有创伤小、恢复快、费用低的优点,有良好的临床推广价值。Objective： To compare the effect between endoscopic closure and laparoscopic repair for perforation in endoscopic submucosal excavation（ ESE） and Endoscopic full-thickness resection（ EFR） of gastric submucosal tumors originating from the muscularis propria layer（ SMTs）,and to discuss the efficacy and safety of endoscopic closure in treatment of acute perforation. Methods：Totally 40 cases suffering perforation in ESE/EFR of SMTs were assigned to the laparoscopic repair group（ n = 20） and the endoscopic closure group（ n = 20）. Results： There were 38 cases of mesenchymoma and 2 cases of liomyoma diagnosed by pathological examination. There were significant differences in surgical duration and hospitalization costs of patients with perforation diameter less than 0. 5 cm compared between two groups（ P〈0. 05）,but with no significant difference in patients with perforation diameter above than 0. 5 cm between two groups（ P〈0. 05）. There was no case with postoperative hemorrhage,recurrence or metastasis after 5-32 months of followup. Conclusion： Compared with the laparoscopic repair,the endoscopic closure,with advantage of less surgical trauma,rapid recovery and less costs,is effective in treatment of perforation in endoscopic muscularis dissection（ EMD） of SMTs.

关 键 词：胃粘膜下肿瘤 固有肌层肿瘤 内镜下肌层剥离术 内镜切除 治疗性穿孔 腹腔镜辅助胃镜 

分 类 号：R735[医药卫生—肿瘤]