内镜黏膜下剥离术治疗胃肠道间质瘤

Endoscopic submucosal dissection of small gastrointestinal stromal tumors (A report of 10 cases)

目的探讨内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗胃肠道间质瘤(gastrointestinal stromal tumor,GIST)的疗效和安全性。方法对来源于肌层、内镜超声(endoscopic ultrasonography,EUS)诊断GIST者应用头端弯曲的针形切开刀进行ESD治疗:黏膜下注射生理盐水;预切开病变周围黏膜;剥离黏膜下层组织显露肌层GIST,1次性完整切除病变。结果10例来源于肌层的GIST,6例位于胃底,1例位于胃窦,1例位于胃体,2例位于直肠。病变最大直径0.5～2.0cm(平均1.3cm)。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,其余9例病变全部完整剥离。ESD完整剥离病变成功率90.0%(9/10)。ESD手术时间60～150min,平均87.5min。全组未出现ESD术后出血。1例ESD治疗中发现1.0cm裂孔,应用金属夹成功缝合裂孔,未转开腹手术修补。ESD穿孔发生率10.0%(1/10)。术后随访期2～12m,除手术病例外其余9例无病变复发。结论ESD治疗小的来源于肌层的GIST安全、有效,可以完整切除病变,提供完整的病理学诊断资料。

[Objective] To determine the feasibihty of submucosal dissection （ESD） for the removal of the small gastrointestinal stromal tumor （GIST） and to evaluate the efficacy and safety of ESD for this indication. [Methods] GIST originating was managed by ESD with the needle knife after the following procesures： injecting natural saline into the submucosa; pre-cutting the surrounding mucosa of the lesion; dissecting the submucosal tissue to display GIST and resecting the lesion completely. [Results] Of the 10 GISTs, 6 located in gastric fundus, 1 in gastric antrum, 1 in gastric body and 2 in rectum. Lesions ranged from 0.5 to 2.0 cm and a mean resected size was 1.3 cm. Among the 10 lesions, 9 were successfully resected with ESD, 1 had tumor residure in the wound after ESD and receieved an additional operation, and the success rate of ESD was 90.0% （9/10）. The mean ESD operation time was 87.5 min （ranged from 60 to 150 min）. None of the patients had delayed bleeding after ESD. Perforation Occurred in 1 case after the dissection of the GIST, which was typically closed with metallic endoclip without surgical treatment. The perforation rate of ESD was 10.0% （1/10）. Follow up period ranged from 2 to 12 months, and no reocurrence was observed, except for one operation case. [ Conclusions] ESD is an effective and safe endoscopic surgical procedure to resect small GIST, which makes it possible to resect the whole lesion and provide pathological information about the lesion.