消化道黏膜下肿物的内镜下诊断及治疗

The diagnosis and treatment of gastrointestinal submucosal tumor under endoscopy

目的探讨消化道黏膜下肿物的内镜下诊断、治疗及其安全性。方法对261例消化道黏膜下肿物进行内镜及超声内镜检查,并采用内镜黏膜下挖除术(endoscopic submucosal excavation,ESE)、胃镜与腹腔镜双镜联合以及内镜黏膜下隧道肿瘤切除术(submucosal tunneling endoscopic resection,STER)进行肿物切除。结果内镜下通过ESE切除黏膜下肿物213例,胃镜腹腔镜双镜联合切除42例,STER切除6例,确诊胃肠道间质瘤86例、平滑肌瘤85例、脂肪瘤35例、类癌32例、异位胰腺15例、神经鞘瘤4例、错构瘤3例和血管球瘤1例。超声内镜对各种黏膜下肿物的诊断符合率分别为:胃肠道间质瘤(93%)、平滑肌瘤(87%)、脂肪瘤(100%)、类癌(78%)、异位胰腺(80%)、神经鞘瘤(0)、错构瘤(0)和血管球瘤(100%)。所有患者均顺利完整切除瘤体,有3例GIST在内镜下剥离过程中发生了胃壁微小穿孔,通过内镜下钛夹修补达到缝合。另有1例患者发生术后感染,经抗感染治疗后痊愈。所有患者均无术中大出血、术后迟发性出血及死亡病例发生。结论 ESE、胃镜腹腔镜双镜联合以及STER是目前治疗黏膜下肿物微创、有效且安全的方法。

Objective To explore the diagnosis, treatment and safety of gastrointestinal submucosal tumor under en- doscopy. Methods 261 patients with gastrointestinal submucosal tumor were examined by endoscopy and EUS, then they were resected by ESE, laparoscopy combined with endoscopy and STER. Results 213 cases of submueosal tumor were resected by ESE, 42 cases by laparoscopy combined with endoscopy and 6 cases by STER. The diagnosis of gastro- intestinal submucosal tumor was 86 cases of gastrointestinal stromal tumor, 85 cases of gastrointestinal leiomyoma, 35 ca- ses of lipoma, 32 cases of carcinoid, 15 cases of heterotopic pancreas, 4 cases of schwannoma, 3 cases of hamartoma and 1 case of glomus tumor. The endoscopic ultrasound diagnosis rates of gastrointestinal stromal tumor, leiomyoma, li- poma,earcinoid, heterotopic pancreas, schwannoma, hamartoma and glomus tumor were 93% , 87% , 100% , 78% , 80% ,0, 0 and 100% , respectively. All submucosal tumor were resected completed, 3 patients were perforation in stom- ach during the desection and then sutured by titanium clip under endoscopy. One patient was infection after operation and cured by medical treatment. No bleeding and death happened during and after the operation. Conclusion ESE, laparoscopy combined with endoscopy and STER are effective and safe methods in gastrointestinal submucosal tumor treatment.