经口双镜联合切除来源于固有肌层的胃黏膜下肿瘤的临床初探

Endoscopic resection of gastric submucosal tumors originated from muscularis propria layer with double peroral endoscopes： a pilot study

目的探讨经口双镜联合切除来源于固有肌层的胃黏膜下肿瘤的疗效和可行性。方法对2013年3月经辅助检查明确诊断为起源于固有肌层的胃黏膜下肿瘤患者2例，在静脉麻醉下行经口双镜联合切除治疗，辅助镜提拉肿瘤和固有肌层，主镜完整切除病变和牢固夹闭固有肌层创面，观察治疗效果。结果2例胃黏膜下肿瘤，经口双镜联合成功完整切除。术后病理1例为胃间质瘤，1例为平滑肌瘤；病变直径2cm。手术时间分别为48min和66min。术后无一例出现感染、穿孔及出血等并发症。住院时间为8d和6d。结论经口双镜联合切除来源于固有肌层的胃黏膜下肿瘤是可行的，具有一定的优势。

Objective To evaluate the feasibility and efficacy of endoscopic resection of gastric sub- mucosal tumors （SMTs） originated from the muscularis propria layer with double peroral endoscopes. Methods In this study two patients with gastric SMTs by auxiliary examination were enrolled. Endoscopic resection was performed using double peroral endoscopes under general anesthesia. The main endoscope was used to resect the tumor and to close the incision of muscularis propria layer by metal clips, while the ancillary endoscope was used to pull and lift tumors or muscularis propria layer. Treatment effectiveness was observed. Results The two gastric SMTs originated from the muscularis propria layer were removed integrally, and were diagnosed pathologically as gastrointestinal stromal tumor and leiomyoma, respectively. The diameter of the lesions was 2 cm. The procedure time were 48 min and 66 min. No complication including perforation or bleeding was observed. The hospitalization time were 8 d and 6 d. Conclusion Endoscopic resection by double peroral endoscopes,is an efficacious and safe endoscopic procedure to resect gastric SMTs originated from the muscularis propria layer, and is able to achieve the efficacy equivalent to surgery.