体外牙线牵引辅助在内镜全层切除术治疗胃黏膜下肿瘤中的应用

摘要

目的 研究体外牙线牵引辅助在胃黏膜下肿瘤(SMT)内镜全层切除术(EFTR)中的临床应用效果.方法 回顾性分析2016年1月-2016年9月复旦大学附属中山医院使用体外牙线牵引辅助装置并采用EFTR治疗胃SMT的96例患者,观察肿瘤切除率、手术时间、术中出血、术后并发症发生情况;术后内镜随访,评价治疗效果与安全性.结果 96例患者均成功完成EFTR治疗,平均手术时间26.7 min(20~55 min),手术成功率100.0%,肿瘤完全切除率100.0%,肿瘤大小为1.2 cm(0.8~2.5 cm),肿瘤位置贲门下13例(13.5%),胃底46例(47.9%),胃体33例(34.3%),胃窦2例(2.1%),胃角2例(2.1%);术中1例患者出血(1.0%),内镜下止血成功.病理结果间质瘤62例(64.6%),平滑肌瘤31例(32.3%),钙化纤维瘤1例(1.0%),异位胰腺2例(2.1%).患者平均住院时间为4 d(3~7 d),所有患者均无迟发性出血或穿孔.术后3~6个月随访期间所有病例创面愈合良好.结论 EFTR术中应用体外牙线牵引辅助能缩短手术时间,降低术中出血的发生,体外牙线牵引辅助装置在EFTR治疗过程中是一个有效的装置.%Objective To evaluate the clinical efficacy and safety of endoscopic full-thickness resection assisted by dental floss traction in treatment of gastric submucosal tumors. Methods Those patients with gastric submucosal tumors from January 2016 to September 2016 were enrolled in the study. All patients were treated with endoscopic full-thickness resection assisted by dental floss traction. The en bloc resection rate, procedure time were analyzed. Complications such as bleeding and perforation were observed in the procedures. All patients were followed up 3-6 months for evaluation of efficacy and safety. Results 96 patients were recruited into the study. The average surgery time of 26.7 min (20 ~ 55 min), the success rate and the en bloc resection rate was 100.0%. The average tumors sizes was 1.2 cm (0.8 ~ 2.5 cm). The intraoperative bleeding occurred in 1 patient, the incidence rate of bleeding was 1.0% (1/96). The tumors were located cardia in 13 patients (13.5%), gastric fundus in 46 patients (47.9%), in gastric body in 33 patients (34.3%), in antrum in 2 patients (2.1%), in gastric angle in 2 patients (2.1%). Pathological results of interstitial tumor in 62 patients (64.6%), leiomyoma in 31 patients (32.3%), calcifying fibroma in 1 patients (1.0%), ectopic pancreas in 2 patients (2.1%). The median hospital stay was 4 days (3 ~ 7 d). No complications such as fever, abdominal pain were found during during the follow-up of 3 ~ 6 months. Conclusion Endoscopic full-thickness resection assisted by dental floss traction in treatment gastric submucosal tumors is effective and safe.