内镜黏膜下剥离术及全层切除术治疗胃黏膜下肿瘤的临床效果分析  

Analysis of clinical efficacy of endoscopic submucosal dissection and full-thickness resection in the treatment of gastric submucosal tumors

作　　者：徐兆军[1] 张予蜀[1] 张振玉[1] Zhaojun Xu;Yushu Zhang;Zhenyu Zhang(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,南京市210000

出　　处：《中国肿瘤临床》2021年第14期728-732,共5页Chinese Journal of Clinical Oncology

摘　　要：目的:探讨内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)及内镜全层切除术(endoscopic full-thickness resection,EFR)治疗胃黏膜下肿瘤的安全性和有效性。方法:回顾性分析109例胃黏膜下肿瘤患者资料,62例行内镜黏膜下剥离术(ESD组),47例行内镜全层切除术(EFR组)。比较两组基线资料、手术情况、术后并发症、术后住院时间、术后病理结果等。结果:ESD组61例完成内镜手术,1例中转外科腹腔镜手术,平均手术时间(65.08±30.36)min,术中出血量(18.66±30.70)mL,术中有7例发生穿孔,创面或穿孔采用荷包缝合24例,单用金属夹缝合32例,5例创面未缝合;EFR组46例完成内镜手术,1例中转外科腹腔镜手术,平均手术时间(52.13±20.95)min,术中出血量(17.06±23.25)mL,创面穿孔采用荷包缝合25例,单用金属夹缝合21例。ESD组术后迟发性出血2例,迟发性穿孔2例;EFR组术后迟发性出血1例。ESD组术后病理及免疫组织化学诊断间质瘤36例、平滑肌瘤14例、脂肪瘤5例、异位胰腺3例、其他4例,EFR组间质瘤40例,平滑肌瘤3例,其他4例。所有病例术后随访复查无复发。结论:ESD及EFR治疗胃黏膜下肿瘤创伤小、并发症少,安全、有效,值得推广。Objective:To investigate the safety and efficacy of endoscopic submucosal dissection(ESD)and endoscopic full-thickness resection(EFR)in the treatment of gastric submucosal tumors.Methods:The clinical data of 109 patients with gastric submucosal tumor were retrospectively analyzed.Sixty-two patients underwent ESD(ESD group)and 47 patients underwent EFR(EFR group).The baseline data,perioperative status,postoperative complications,duration of postoperative hospital stay,and postoperative pathological results of the two groups were summarized.Results:In the ESD group,61 patients completed endoscopic surgery,and one underwent laparoscopic surgery.The average operation time was(65.08±30.36)min,and amount of intraoperative blood loss was(18.66±30.70)mL.Seven patients had a perforation;24 wounds or perforationswere sutured with a purse string,32 were sutured with a metal clip,and 5 were not sutured.In the EFR group,46 patients completed endoscopic surgery,and one underwent laparoscopic surgery.The average operation time was(52.13±20.95)min,and the amount of bleeding was(17.06±23.25)mL.Twenty-five patients were sutured with a purse string,while 21 cases were sutured with a metal clip.There were two patients with delayed hemorrhage and two with delayed perforation in the ESD group,and there was one patient with delayed hemorrhage in the EFR group.In the ESD group,there were 36 cases of stromal tumor,14 cases of leiomyoma,5 cases of lipoma,3 cases of ectopic pancreas,and 4 cases of others,while in the EFR group,there were 40 cases of stromal tumor,3 cases of leiomyoma,and 4 cases of others.There was no recurrence observed in any patient.Conclusions:ESD and EFR are safe and effective in the treatment of gastric submucosal tumors with less trauma and complications.

关 键 词：胃黏膜下肿瘤 内镜黏膜下剥离术 内镜全层切除术 治疗 

分 类 号：R735.2[医药卫生—肿瘤]