摘要
目的:评价内镜下圈套器法黏膜切除术(Endoscopic mucosal resection with ligator device,EMR-L)对上消化道间质瘤治疗的临床有效性、安全性,技术的可行性。方法:回顾性分析我院消化内科从2007年5月到2011年5月行EMR-L治疗的上消化道间质瘤患者共53例。EMR-L包括吸引-圈套-切除-封闭4步,在常规的EMR-L基础上有两点改进:一是结扎2个橡胶圈,二是在圈套后形成的假蒂基部两端黏膜面各固定肽夹1枚。观察患者临床特点、内镜表现、EMR-L术及其并发症和病理检查结果,术后定期胃镜随访。结果:共有53例患者纳入本次研究,平均年龄为51.7岁(22～76)岁,男女比例为1∶2.3(16∶37),肿瘤平均大小为0.95 cm(0.3～2.5)cm,EMR-L成功切除51例(成功率为96.2%),2例失败转外科手术治疗,手术平均时间为25min(14～56)min。EMR-L相关并发症包括胃穿孔4例(7.5%),胸骨后不适5例(9.4%)、上腹不适5例(9.4%)。术后病检均证实为间质瘤,其中食管间质瘤23例,胃间质瘤30例。随访3～43月(平均13.5月)1例复发,复发率为1.9%。结论:EMR-L对于≤2.5 cm局限性上消化道间质瘤是一种简单、快速、安全、有效和可行性的治疗措施。
Objective：To evaluate the clinical efficacy,safety,and technical feasibility of endoscopic mucosal resection with ligator device（EMR-L） for gastrointestinal stromal tumors（GISTs） of upper gastrointestinal tract.Methods：This is a retrospective medical record review,which includes fifty-three consecutive patients,who underwent EMR-L for GISTs in upper GI tract from May,2007,to May,2011.Our EMR-L includes four steps as suction,ligation,snare and closure,which has two improvements compared with conventional EMR-L.One is ligating two elastic bands,and the other is fixing two clips before snare.The outcome measures included：baseline patient characteristics,endoscopic outcomes,procedural complications,pathological outcomes,and follow-up outcomes.Results：A total of 53 patients were eligible for inclusions in the study,the mean age being 51.7（range 22~76）years,the male/female ratio being 1∶2.3（16∶37）.The tumors were all protruding lesions with hemisphere or strip shape,and the mean lesion size under EUS was 0.95（range 0.3~2.5） cm.EMR-L was easily and successfully performed in 51 patients（success rate,96.2%）,but failed in 2 patients who turned to surgery treatment.The mean procedure time was 25（range,14~56） minutes.Serious complications included gastric perforation 7.5%（4 of 53）;mild complications included retrosternal discomfort 9.4%（5 of 53） and abdominal discomfort 9.4%（5 of 53）.The postoperative histological diagnosis was GISTs for all cases,37.7%（23 of 53） in esophagus and 62.3%（30 of 53） in stomach.During a mean follow-up period of 13.5 months（range,3~43 months）,there was only one recurrence observed 12 months postoperatively with the recurrence rate of 1.9%.Conclusion：EMR-L is an effective,safe and feasible endoscopic modality for the treatment of small（≤2.5 cm） upper GISTs.
出处
《重庆医科大学学报》
CAS
CSCD
北大核心
2012年第1期79-83,共5页
Journal of Chongqing Medical University
关键词
胃肠道间质瘤
内镜下黏膜切除术
圈套器
内镜下微创治疗
gastrointestinal stromal tumors
endoscopic mucosal resection
ligator device
minimally invasive endoscopy
