直径2~5 cm的胃间质瘤的内镜下切除疗效分析  

Endoscopic resection for gastric stromal tumor with diameter of 2 to 5 cm

作　　者：蔡红岩 李庭赞[1] 张扬 艾小明[2] CAI Hongyan;LI Tingzan;ZHANG Yang;AI Xiaoming(Department of Gastroenterology,BenQ Medcial Center Affiliated to Nanjing Medical University,Nanjing,Jiangsu 210019,China;不详)

机构地区：[1]南京医科大学附属明基医院消化内科,江苏南京210019 [2]南京医科大学附属明基医院普外科,江苏南京210019

出　　处：《中国临床研究》2023年第9期1317-1321,共5页Chinese Journal of Clinical Research

基　　金：南京市医学科技发展基金项目(YKK20218)。

摘　　要：目的评估内镜下切除对直径2~5 cm的胃间质瘤(GST)的临床疗效。方法回顾性分析2017年1月至2021年1月南京医科大学附属明基医院收治的42例直径2~5 cm的GST患者的临床资料,所有患者均接受内镜下切除治疗。对患者的病例特点、内镜下切除术式、术中情况、术后恢复和预后情况以及术中术后并发症等进行分析。结果38例成功完成内镜下切除,4例切除失败。34例手术标本顺利取出,8例在胃腔内切割分块后取出。所有患者病灶均已完整切除,其中38例切缘阴性、4例切缘阳性。18例术中穿孔,其中4例意外被动穿孔,14例主动穿孔;7例术中大出血;5例术后穿孔;4例术后大出血;6例术后感染。1例术后2年发现多个腹腔转移灶,现仍带瘤生存。结论对于直径2~5 cm的GST,内镜下切除手术的疗效显著,但其操作难度和风险剧增。内镜医师需熟练掌握多种内镜操作术式和技巧,必要时及时寻求外科支持。Objective To evaluate the clinical efficacy of endoscopic resection for the patients with 2-5 cm gastric stromal tumor(GST).Methods A retrospective analysis was made on the clinical data of 42 patients with 2-5 cm GST who underwent endoscopic surgery in BenQ Medical Center Affiliated to Nanjing Medical University from January 2017 to January 2021.The patients characteristics,the procedures of endoscopic resection,intraoperative conditions,postoperative recovery and prognosis as well as intra-and post-operative complications were analyzed.Results Endoscopic resection was successfully completed in 38 cases and failed in 4 cases.The surgical specimens were removed successfully in 34 cases and after being cut into pieces in the gastric cavity in 8 cases.Among all lesions completely removed,there were 38 cases with negative margins and 4 cases with positive margins.The intraoperative perforation occurred in 18 cases,including 4 cases of accidental perforation and 14 cases of active perforation.There were 7 cases of massive intraoperative bleeding,5 cases of postoperative perforation,4 cases of significant postoperative bleeding and 6 cases of postoperative infection.One case was found to have multiple abdominal metastases 2 years after surgery,but still survived with the tumor.Conclusion For GST with diameter of 2-5 cm,endoscopic resection surgery has a significant therapeutic effect,but the difficulty and risk of operation also increase significantly.Endoscopists need to master a variety of endoscopic procedures and skills,and seek surgical support in time if necessary.

关 键 词：胃间质瘤 内镜下切除 内镜黏膜下剥离术 内镜黏膜切除术 内镜黏膜下挖除术 经黏膜下隧道内镜肿瘤切除术 内镜下全层切除术 

分 类 号：R735.2[医药卫生—肿瘤]