圈套器联合钛夹牵引法在内镜切除胃黏膜下肿瘤术中的应用  

Application of Snare Combined With Endoclips Traction in Endoscopic Resection of Gastric Submucosal Tumor

作　　者：姜中华 孔施施 孙静霞 王星 刘郑培 范志宁 Jiang Zhonghua;Kong Shishi;Sun Jingxia(Department of Gastroenterology,Yancheng Clinical College of Xuzhou Medical University,First People’s Hospital of Yancheng,Yancheng 224006,China;不详)

机构地区：[1]盐城生物工程高等职业技术学校,盐城224051 [2]南京医科大学第一附属医院消化内镜科,南京210029 [3]徐州医科大学盐城临床学院,盐城市第一人民医院消化科,盐城224006

出　　处：《中国微创外科杂志》2022年第9期717-721,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：江苏省基础研究计划面上项目(BK20211116);2018年盐城市科技发展计划项目(YK2018006)。

摘　　要：目的评估圈套器联合钛夹牵引法在内镜切除胃黏膜下肿瘤术中的应用价值。方法回顾性分析2019年1月~2020年6月49例胃黏膜下肿瘤行圈套器联合钛夹牵引辅助内镜切除的资料。肿瘤位于胃底16例,胃体18例,胃窦7例,胃角8例。肿瘤长径1.0~3.5 cm,中位数2.3 cm。肿瘤起源于黏膜肌层或黏膜下层11例,固有肌层38例。奥林巴斯Dual刀或IT刀切除瘤体表面黏膜暴露瘤体,圈套器联合钛夹牵引瘤体切开的一侧缘,腔内生长为主的瘤体采用非全层切除,腔外生长为主的瘤体采用全层切除。结果非全层切除18例,全层切除31例,圈套器联合钛夹牵引法均能有效暴露手术视野,均整块切除,术后住院时间3~8 d,中位数5 d。未发生术中和术后严重并发症。49例随访时间25~39个月,(32.0±4.2)月,胃镜及全腹部增强CT未见复发。结论圈套器联合钛夹牵引法是内镜切除黏膜下肿瘤有效的辅助方法,高效,安全。Objective To evaluate the value of snare combined with endoclips traction in endoscopic resection of gastric submucosal tumors.Methods Clinical data of 49 cases of gastric submucosal tumors who underwent snare combined with endoclips traction assisted endoscopic resection from January 2019 to June 2020 were retrospectively analyzed.There were 16 cases of gastric fundus tumor,18 cases of gastric body tumor,7 cases of gastric antrum tumor,and 8 cases of gastric angle tumor.The median length of tumor was 2.3 cm(range,1.0-3.5 cm).The tumors originated from mucosal muscle or submucosa in 11 cases and from muscularis propria in 38 cases.To expose the tumor,the mucous membrane of the tumor was removed with an Olympus Dual knife or IT knife.A snare combined with endoclip device was used to drag the side edge of the tumor.The tumors with dominant intra luminal growth and dominant extra luminal growth were resected by non-full-thickness resection and full-thickness resection,respectively.Results There were 18 cases with non-full-thickness resection and 31 cases with full-thickness resection.The traction of snare combined with endoclips effectively exposed the surgical field,and all the cases were treated with whole resection.The median postoperative hospital stay was 5 d(range,3-8 d).No serious intraoperative and postoperative complications occurred.All the 49 patients were followed up for 25-39 months,with an average of(32.0±4.2)months.No recurrence was observed by gastroscopy and CT scanning.Conclusion Snare combined with endoclips traction is an effective and safe auxiliary method for endoscopic resection of submucosal tumors.

关 键 词：胃黏膜下肿瘤 内镜切除 圈套器 

分 类 号：R735.2[医药卫生—肿瘤]