内镜全层切除术及黏膜下剥离术治疗胃间质瘤的临床效果分析  

Analysis of Clinical Effect of Endoscopic Full-thickness Resection and Endoscopic Submucosal Dissection in the Treatment of Gastric Stromal Tumors

作　　者：徐兆军[1] 张予蜀[1] 张振玉[1] XU Zhao-jun;ZHANG Yu-shu;ZHANG Zhen-yu(Department of Gastroenterology,Nanjing Hospital Affiliated to Nanjing Medical University,Nanjing 210000,China)

机构地区：[1]南京医科大学附属南京医院消化科,江苏南京210000

出　　处：《现代诊断与治疗》2020年第24期3867-3870,共4页Modern Diagnosis and Treatment

摘　　要：目的探讨内镜全层切除术及黏膜下剥离术治疗胃间质瘤的安全性和有效性。方法选取我院收治的63例胃间质瘤患者,38例行内镜全层切除术(EFR组),25例行内镜黏膜下剥离术(ESD组)。对比两组围手术期情况、术后并发症、术后住院时间、术后病理情况等。结果两组均完成内镜手术,均完整切除肿瘤。EFR组平均手术时间48.45±22.76min,术中出血量14.05±19.02ml,创面穿孔采用荷包缝合19例,单用金属夹缝合19例;ESD组平均手术时间71.04±36.87min,术中出血量71.04±36.87ml,术中有5例发生穿孔,均为肌层深层肿瘤,创面或穿孔采用荷包缝合10例,单用金属夹缝合15例。EFR组术后并发症发热3例,迟发性出血1例;ESD组术后并发症发热2例,迟发性穿孔1例。EFR组术后病理及免疫组化诊断极低危险度26例,低度危险11例,高度危险1例;ESD组极低危险度19例,低度危险5例,高度危险1例。结论ESD及EFR治疗胃间质瘤安全、有效、创伤小、并发症少,ESD适合于起源于肌层浅层胃间质瘤,而EFR更适合于治疗肌层深层的胃间质瘤。Objective To investigate the safety and efficacy of endoscopic full-thickness resection and endoscopicsubmucosal dissection in the treatment of gastric stromal tumors.Methods The clinical data of 63 patients with gastric stromal tumorwas collected.38 patients(n=38)were treated with endoscopic full-thickness resection(EFR group),and 25 patients(n=25)were treated with endoscopic submucosal dissection(ESD group).The perioperative conditions,postoperative complications,postoperative hospital stay and postoperative pathologyof the two groups were analyzed.Results Endoscopic surgery was completed in both groups,and the tumors were completely removed.In the EFR group,the average operation time was 48.45±22.76min,and the intraoperative blood loss was 14.05±19.02ml.In the ESD group,the average operation time was 71.04±36.87min,and the intraoperative blood loss was 71.04±36.87ml.In the ESD group,there were 5 cases of perforation,all of which were deep muscle tumors.The wound or perforation were sutured with purse string suture in 10 cases and metal clips in 15 cases.There were 3 cases of fever and 1 case of delayed hemorrhage in EFR group,2 cases of fever and 1 case of delayed perforation in ESD group.In EFR group,there were 26 cases with extremely low risk,11 cases with low risk and 1 case with high risk by pathology and immunohistochemistry;In ESD group,there were 19 cases with extremely low risk,5 cases with low risk and 1 case with high risk in ESD group.Conclusion ESD and EFR were safe,effective,less invasive and less complications in the treatment of gastric stromal tumors.ESD was suitable for superficial gastric stromal tumors,while EFR was more suitable for the treatment of gastric stromal tumors in deep muscular layers.

关 键 词：胃间质瘤 内镜全层切除术 内镜黏膜下剥离术 

分 类 号：R735[医药卫生—肿瘤]