摘要
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.
出处
《中国医学工程》
2007年第12期945-948,953,共5页
China Medical Engineering
关键词
内镜黏膜下剥离术
内窥镜外科手术
胃肠道间质瘤
endoscopic submucosal dissection (ESD)
endoscopic surgical procedure
gastrointestinal stromal tu- mor (GIST)