胃肠道间质瘤治疗新方法的探讨

摘要

Objective To explore the efficacy and safety of laparoscopy combined with endoscopy,endoscopic submucosal excavation (ESE) and submucosal tunneling endoscopic resection (STER) in treatment of gastrointestinal stromal tumor (GIST).Methods 86 patients were identified gastrointestinal stromal tumor by endoscopy,endoscopic ultrasonography,pathology and immunohistochemical methods.53 patients underwent ESE,29 patients underwent laparoscopy combined with endoscopy,and 4 patients underwent STER.Results All patients were resected the tumor completely.There were 56 cases in very low risk,17 cases in low risk,8 cases in median risk and 5 cases in high risk after operation.No bleeding and abodminal pain happened during and after the operation.Patients with gastric cardia tumor remained good cardia function after the tumor resection without reflux.1 patient was recurrent after the dissection because he refused to take imatinib and the other patients had no metastasis and recurrence.Conclusion Laparoscopy combined with endoscopy,ESE and STER are minimal invasive,safe and effective new methods in gastrointestinal stromal tumor therapy.%目的 探讨胃镜与腹腔镜双镜联合、内镜黏膜下挖除术(endoscopic submucosal excavation,ESE)及内镜黏膜下隧道肿瘤切除术(submucosal tunneling endoscopic resection,STER)治疗胃肠道间质瘤(GIST)的效果和安全性.方法 经胃(肠)镜、超声内镜及病理学、免疫组化证实GIST患者86例,对其中53例患者采用ESE、29例患者采用胃镜与腹腔镜双镜联合、4例患者采用STER法进行瘤体切除.结果 ESE、双镜联合及STER治疗的所有患者均完整切除瘤体,术后风险评估极低危56例、低危17例、中危8例、高危5例.三种方法均无术中及术后迟发性出血、剧烈腹痛等并发症,瘤体位于贲门者切除后患者贲门功能保持良好,术后随访无反流性食管炎等并发症.术后随访有1例中危GIST患者因术后未服用格列卫发生盆腔转移,其他患者无远处转移及复发.结论 胃镜与腹腔镜双镜联合技术、ESE及STER是治疗胃肠道间质瘤的微创、安全、有效的新方法.