内镜下治疗胃固有肌层间质瘤的疗效和安全性

Endoscopical therapy for the treatment of gastric stromal tumor originating from the muscularis propria layer

目的：探讨内镜下治疗胃固有肌层间质瘤的疗效和安全性。方法选择2011年3月至2013年6月于烟台毓璜顶医院消化内镜中心行内镜超声（EUS）发现的34例源于胃固有肌层的黏膜下肿瘤（SMTs），根据其大小、层次分别进行内镜下结扎切除术（ELR）治疗7例、内镜黏膜下挖除术（ESE）治疗21例，内镜全层切除术（EFR）治疗6例。结果34例源于胃固有肌层的 SMTs 均成功挖除，4例 ESE 治疗中发生穿孔，应用金属止血夹成功夹闭。其中 ESE 及 EFR术后病理诊断为间质瘤，其中胃底16例，胃体16例，胃窦2例。病变最大直径0.7～4.3 cm，平均最大直径1.5㎝。全组未出现 ESE 术后出血，随访2～30个月，恢复良好，未出现复发或转移。结论内镜下切除治疗小的胃固有肌层间质瘤安全、有效，能一次性完整切除病变，ESE 及 EFR可提供完整的病理诊断资料，且所有内镜下治疗患者术后恢复快，疗效较好。

Objective Toexploretheefficacyandsafetyofendoscopicligationresection(ELR), endoscopic submucosal excavation (ESE) and endoscopic full-thickness resection (EFR)for gastric stromal tumor originating from gastric muscularis propria layer. Methods From March 2011 to June 2013, 34 cases of patients with gastric submucosal tumors (SMTs) originating from the muscularis propria layer were managed by ELR, ESE, EFR after endoscopic ultrasonography (EUS) in Yantai Yuhuangding Hospital. Results ELR, ESE, EFR were successfully accomplished to remove all tumors in 34 patients. Perforation occurred in 4 cases after the dissection of the lesions,which were typically closed with metallic endoclip without surgical treatment. These 34 lesions were diagnosed pathologically as gastrointestinal stromal tumor (GIST), and 16 located in gastric fundus, 16 in gastric body, 2 in gastric antrum. The size of tumors ranged from 0.7 to 4.3 cm ( mean 1.5 cm) in diameter.None of the patients had delayed bleeding after ESE. Follow-up period ranged from 2 to 30 months, and no reoccurrence or metastasis was observed. Conclusion It is safe and effective of endoscopical therapy for the treatment of gastric stromal tumor originating from the muscularis propria layer, and can resect the whole lesion and provide pathologic information about the lesion.The patients had rapid recovery and good efficacy after operation.