超声内镜辅助套扎术在胃固有肌层小肿瘤全层切除中的应用  

Application of Endoscopic Ultrasonography Assisted Ligation on Full-Thickness Resection of Small Tumors in Gastric Intrinsic Muscle Layer

作　　者：葛存锦[1] 仝巧云[1] 周明东[1] 李中艳[1] Ge Cunjin;Tong Qiaoyun;Zhou Mingdong;Li Zhongyan(Department of Gastroenterology, Yichang Central People's Hospital, The First College of Clinical Medical Science, China Three Gorges University, Yichang 443003, China;Institute of Digestive Diseases, China Three Gorges University, Yichang 443003, China)

机构地区：[1]三峡大学第一临床医学院(宜昌市中心人民医院)消化内科&三峡大学消化疾病研究所

出　　处：《巴楚医学》2019年第2期20-24,共5页Bachu Medical Journal

摘　　要：目的:探讨超声内镜辅助套扎术在胃固有肌层小肿瘤全层切除中的疗效及安全性。方法:选择2016年3月至2017年12月我院消化内科行超声内镜辅助套扎后,使用圈套器全层切除胃固有肌层小肿瘤的54例患者为研究对象。对患者进行静脉麻醉后,先行超声内镜确认肿瘤位置,然后使用COOK套扎环进行套扎,套扎后再次超声内镜确认肿瘤位于套扎球内,使用圈套器于套扎环基底部全层圈套切除,全层切除后穿孔创面用可旋转重复开闭软组织夹缝合。结果:内镜下圈套切除的54例患者瘤体均来源于固有肌层,瘤体直径为10.2±3.0mm,一次性套扎成功率为94.44%,二次套扎成功率为100%,完整切除率为100%,平均手术时间为20.2±4.1min,平均使用金属夹数量为5.0±1.2枚。术后病理诊断胃间质瘤39例,胃平滑肌瘤14例,胃神经纤维瘤1例。术后1w均未发生迟发性出血、穿孔等并发症,术后随访12m均未发现复发、残留等情况。结论:超声内镜辅助套扎后胃固有肌层小肿瘤全层切除的操作简单,可完整切除肿瘤,且并发症发生率低,对判断肿瘤性质及患者预后具有一定意义。Objective: To investigate the efficacy and safety of endoscopic ultrasonography assisted ligation on full-layer resection of small tumors in gastric intrinsic muscle layer.Methods: There were 54 cases with full-thickness resection of small tumors in gastric intrinsic muscle layer in our department from March 2016 to December 2017 selected for further study.After intravenous anesthesia, the location of the tumor was first confirmed by endoscopic ultrasonography, and then ligated using COOK ligation ring.After ligation, the tumor was confirmed in the ligation ball by endoscopic ultrasonography again.The whole layer was removed by a snare device, and the perforated wound was stitched with soft tissue holder.Results: It was confirmed that all the tumors were derived from the intrinsic muscle layer by endoscopic surgery.The tumor diameter was 10.2±3.0 mm.The successful rate of one-time ligation and second ligation were 94.44% and 100%, respectively.The complete resection rate was 100%.The average operation time was 20.2±4.1 min, and the average number of metal clips was 5.0±1.2.There were 39 cases of gastric stromal tumor, 14 cases of gastric leiomyoma, and 1 case of gastric neurofibroma, which were diagnosed by postoperative pathology.No complications including delayed bleeding or perforation occurred one week after operation.No recurrence or residue was found one year postoperative follow-up.Conclusion: Endoscopic ultrasonography assisted ligation on full-layer resection of small tumors in gastric intrinsic muscle layer is easy to operate, and the tumor can be completely resected with low incidence of complications, which is worthy of determination of tumor properties and prognosis of patients.

关 键 词：胃固有肌层小肿瘤 超声内镜辅助套扎术 全层切除 

分 类 号：R536.1[医药卫生—内科学]