内镜下肿瘤挖除术治疗固有肌层来源胃肿瘤的临床分析

摘要

目的 探讨内镜黏膜下肿瘤挖除术(endoscopic submucosal excavation,ESE)治疗固有肌层的胃黏膜下肿瘤(submucosal tumor,SMT)的临床疗效.方法 收集2014年2月至2017年2月行ESE治疗的59例固有肌层来源的SMT患者的资料,对其临床特征、ESE后的病理诊断、并发症及发生并发症的危险因素进行分析.结果 完成整块切除58例(98.3％),1例转为外科手术.病理学诊断为胃肠道间质瘤51例,平滑肌瘤7例,神经鞘瘤1例.术后并发胃穿孔7例,均经钛夹封闭创面及内科保守治疗后痊愈.在后期随访中,未发现残余肿瘤和肿瘤复发.术中并发穿孔的可能危险因素有:肿瘤直径、病变深度、患者年龄(P＜0.05或0.01).结论 对于来源于固有肌层的SMT,行ESE治疗安全、有效.病变直径较大、病变部位深、年龄大的患者,并发胃穿孔的风险更大.%Objective To evaluate the safety,efficacy and complication of endoscopic submucosal excavation (ESE) for the resection of gastric submucosal tumors(SMTs) originating from the muscularis propria(MP).Methods Fifty nine patients with gastric SMTs of MP origin underwent ESE from January 2014 to January 2017 in our department.The characteristics of patients,and the clinical efficacy,safety of ESE,and pathological diagnoses were evaluated retrospectively.Results ESE was successfully performed in 58 cases,and one case was converted to open surgery.According to post-ESE pathological diagnosis,there were 51 cases of gastrointestinal stromal tumors,7 cases of leiomyomas,and 1 case of schwannoma.Seven patients developed perforation after operation,and all recovered after sealing the wound with titanium clip and conservative treatment.No residual or recurrent tumors were detected during the follow-up period.The risk factors for intraoperative perforation were tumor diameter,depth of lesion,and age of patients (P＜0.05 or 0.01).Conclusion ESE seems to be a feasible,safe,effective minimally invasive procedure for the resection of large gastric tumors originating fromthe MP.Larger tumor size,deeper lesion site and advanced age are risk factors for intraoperative perforation during ESE treatment.