内镜黏膜下剥离术治疗胃固有肌层肿瘤的疗效和安全性

Endoscopic submucosal dissection for tumors originating from gastric muscularis propria

目的探索内镜黏膜下剥离术治疗胃固有肌层肿瘤的可行性、疗效及安全性。方法对胃镜发现并由超声内镜和CT证实的胃固有肌层来源的肿瘤行内镜黏膜下剥离术治疗，若出现穿孔或难以完整切除的情况则给予腹腔镜介入治疗。结果共对20例患者成功进行内镜黏膜下剥离术治疗，操作时间40～120min，平均74．8min。切除肿瘤的最大直径1．5～3．5cm，平均2．6cm。其中3例因出现较大穿孔而需腹腔镜介入进行全层切除。所有患者均无严重并发症。术后病理诊断17例为间质瘤，3例为平滑肌瘤。结论内镜黏膜下剥离术治疗胃固有肌层肿瘤是安全有效的方法；部分肿瘤的完整切除需要腹腔镜的帮助。

Objective To explore the feasibility, efficacy and safety of endoscopic submucosal dissection （ESD） for tumors originating from gastric muscularis propria. Methods A total of 20 patients with tumors originating from gastric muscularis propria confirmed by EUS and CT scan underwent ESD. Laparoscopic intervention was applied in 3 cases when difficulties in en bloc removal or perforation occurred. Resuits The mean ESD procedure time was 74. 8 min （40-120 min）, and the mean resected tumor size was 2. 6 cm （ 1.5-3.5 cm）. No severe complication occurred. Pathological findings were 17 cases of gastrointestinal stromal tumors and 3 cases of leiomyoma. Conclusion ESD is an effective method for treating the tumors originating from gastric muscularis propria, and laparoscopic intervention is necessary for en bloc resection in some cases.