摘要
目的探讨内镜黏膜下剥离术（ESD）治疗胃肠道间质瘤（GIST）的疗效和安全性。方法对来源于肌层、内镜超声（EUS）诊断GIST的20例患者应用头端弯曲的针形切开刀进行ESD治疗：（1）黏膜下注射生理盐水；（2）预切开病变周围黏膜；（3）剥离黏膜下层组织显露肌层GIST，一次性完整切除病变。结果共计20例来源于肌层的GIST，其中12例位于胃底，1例位于胃窦，3例位于胃体，4例位于直肠。病变直径0．5—3．2（平均1．6）cm。19例（95．0％）患者的病变全部完整剥离，1例ESD剥离病变后创面仍有肿瘤残留，后行外科手术扩大切除治疗。ESD手术时间60－150（平均87．5）min。全组未出现ESD术后出血。3例（15．0％）ESD治疗中发生穿孔，应用金属夹成功闭合裂孔，均未中转开腹手术修补。术后随访期2—12个月，19例病变完整剥离者未见肿瘤复发。结论ESD治疗小的、来源于肌层的GIST安全、有效，病变可以被完整切除并提供完整的病理学诊断资料。
Objective To evaluate the efficacy and safety of endoscopic submucosal dissection （ESD） for the removal of small gastrointestinal stromal tumor （GIST）. Methods GIST diagnosed by endoscopic ultrasonography （EUS） was managed by ESD with the needle knife as follows： （1）Injecting normal saline into the submucosa. （2）Pre-cutting the surrounding mucosa of the lesion. （3） Dissecting the submucosal tissue to display GIST and resecting the lesion completely. Results Of 20 GISTs, 12 located in gastric fundus, and 1 in gastric antrum, 3 in gastric body and 4 in rectum. Lesion diameter ranged from 0.5 to 3.2 cm and the mean resected size was 1.6 cm. Among 20 lesions, 19 were resected with ESD completely, and 1 received additional operation because of tumor residual in the wound after ESD. The successf rate of ESD was 95.0% （19/20）. The mean ESD procedure time was 87.5 rain （ranging from 60 to 150 min）. None of the patients had delayed bleeding after ESD. Perforations occurred in 3 cases after the dissection of the GIST, which were closed with metallic endoclips without additional surgical suture. The perforation rate of ESD was 15.0% （3/20）. The follow up ranged from 2 to 12 months, and no recurrence was observed by EUS except the abovementioned case undergone additional operation. Conclusion ESD is effective and safe for small GIST, which can resect the whole lesion and provide pathological information.
出处
《中华胃肠外科杂志》
CAS
2008年第3期219-222,共4页
Chinese Journal of Gastrointestinal Surgery
关键词
内镜黏膜下剥离术
内镜外科手术
胃肠道间质肿瘤
Endoscopic submucosal dissection
Endoscopic surgical procedure
Gastrointestinal stromal tumors
