超声内镜辅助内镜黏膜下剥离术治疗起源于固有肌层的胃黏膜下肿瘤的价值及影响因素分析  

Endoscopic submucosal dissection with endoscopic ultrasonography assistance for gastric submucosal tumors originated from muscularis propria layer

作　　者：王艳[1] 张海燕[1] 鹿博[1] 吴明波[1] 周甜[1] Wang Yan;Zhang Haiyan;Lu Bo;Wu Mingbo;Zhou Tian(Department of Gastroente rology,Xuzhou Central Hospital,Jiangsu 221009,China)

机构地区：[1]江苏省徐州市中心医院消化内科,221009

出　　处：《山西医药杂志》2018年第9期971-974,共4页Shanxi Medical Journal

基　　金：徐州市中心医院硕士创新团队课题(XZS201675)

摘　　要：目的评估超声内镜辅助内镜黏膜下剥离术治疗起源于固有肌层的黏膜下肿瘤(SMT)的疗效及安全性。方法 2013年12月至2016年12月共79例超声内镜诊断起源于固有肌层的SMT的患者行内镜下切除治疗,术前通过超声内镜对肿瘤进行全面评估,术后对手术完整切除率及并发症发生率进行统计,并对影响手术完整切除及并发症的因素进行分析,随访1年。结果 79例患者,72例行内镜黏膜下剥离术(ESD),7例行内镜下全层切除术(EFR),本研究中SMT于胃上1/3部发生率最高43%(34/79),间质瘤发生率最高63%(50/79),ESD完整切除率为92%(66/72),EFR完整切除率为100%(7/7),瘤体与固有肌层粘连范围是瘤体能否完整切除的重要影响因素,差异有统计学意义(P<0.05)。ESD术后13例出现穿孔,穿孔率为18%(13/72),10例穿孔的病例起源于固有肌层深层并且与固有肌层粘连范围大,8例通过内镜下钛夹夹闭或缝合术封闭创面,5例行腹腔镜手术治疗。瘤体位于固有肌层的深度及瘤体与固有肌层粘连范围是术后穿孔的主要影响因素,差异有统计学意义(P<0.05)。结论通过超声内镜术前评估SMT起源于固有肌层的深度以及与固有肌层粘连的范围,有助于提高ESD完整切除率和减少术中并发症的发生,超声内镜辅助ESD治疗起源于固有肌层的胃SMT是安全有效的。Objective To evaluate the efficacy and safety of endoscopic submucosal dissection（ESD）with endoscopic ultrasonography（EUS）assistance for gastric submucosal tumors（SMTs）originated from muscularis propria layer.Methods A total of 79 patients of SMT originated in the muscularis propria was resected by ESD or endoscopic full-thickness resection（EFR）from December 2013 to December 2016.EUS was performed in 79 cases before resection,and the charts were retrospectively reviewed to investigate the predictive parameters for complete resection and complications.Results Of 79 gastric SMTs,ESD was performed on 72 patients and EFR was performed on 7 patients.The most frequent location of SMTs was upper 1/3 of stomach.The most common pathological diagnosis was gastrointestinal stromal tumor（GIST）,The complete resection rates of ESD and EFR were92%（66/72）and 100%（7/7）respectively.The length of the tumor connection with the muscularis propria layer was significantly associated with a complete resection（P〈0.05）.The perforation of ESD was 18%（13/72）,the length of the tumor connection with the muscularis propria（P〈0.05）and tumor capsular location in the muscularis propria layer（P〈0.05）were significantly associated with perforation.Conclusion A preoperative evaluation the tumor capsular location in muscularis propria layer and the length of the tumor connection with muscularis propria layer by EUS can improve the complete resection rate and reduce the occurrence of complications.ESD is a safe,efficacious procedure for patients with gastric SMTs originated from muscularis propria layer.

关 键 词：胃黏膜下肿瘤 内镜黏膜下剥离术 镜下全层切除术 固有肌层 

分 类 号：R735.2[医药卫生—肿瘤]