内镜下切除联合皮圈结扎闭合术在胃固有肌层肿瘤治疗中的价值探讨

Value inquiry of combination of endoscopic resection and endoscopic band ligation closure in treatment of gastric submucosal tumors originated from the muscular is propria layer

目的探讨内镜超声指导内镜下切除联合皮圈结扎闭合术治疗源于固有肌层的胃黏膜下肿瘤(SMT)的疗效和安全性。方法对内镜发现的胃SMT行内镜超声检查,对其中来源于固有肌层的SMT行皮圈套扎联合高频电切除术,完整切除病变,创面采用皮圈结扎结合钛夹闭合术缝合。结果来源于固有肌层的胃SMT 32例,术后病理诊断为胃间质瘤23例,胃平滑肌瘤7例,胃神经纤维瘤1例,胃血管球瘤1例。病变直径4～12 mm(平均9.6 mm)。32例病变均一次性完整切除,31例术后出现消化道穿孔,应用尼龙圈结合钛夹闭合术成功封闭,未转外科手术。结论内镜超声指导内镜下切除联合皮圈结扎闭合术治疗源于固有肌层直径的胃SMT是安全、有效的,可完整切除病变,创面完全闭合,提供完整的病理学诊断资料,达到与外科手术同样的治疗效果。

[ Objective ] To evaluate the efficacy and safety of endoscopic resection combined with endoscopic band ligation closure for removal of gastric submucosal tumors （SMTs） originated from the muscularis propria layer after examination with endoscopic ultrasonography（EUS）. [ Methods ] Patients with gastric SMT under endoscopy received EUS, and the SMT originated from the muscularis propria layer were removed endoscopically. The lesions were band ligation combined with snare cauterization, and were resected completely. The wound was sutured by applying clips combined with nylon cord. [ Results ] A total of 32 SMTs originated from the muscularis propria layer were removed, in which 23 lesions were diagnosed pathologically as gastrointestinal stromal tumor, 7 as leiomyoma, 1 as gastric neurofibroma, and 1 as gastric glomangioma. The diameter of the lesions ranged from 4 to 12 mm with a mean size of 9.6 mm. Postoperative perforation occurred in 31 cases, who received successful closure with band ligation combined with nylon cord without surgical treatment. [ Conclusion ] Endoscopic resection combined with endoscopic band ligation closure, an effective and sat~ endoscopic surgical procedure to resect gastric SMT originated from the muscularis propria layer, is able to provide pathologic data and achieve the efficacy equivalent to surgery..