内镜下黏膜下挖除术切除胃固有肌层来源的黏膜下肿瘤

Endoscopic submucosal excavation for the treatment of gastric submucosal tumor originated from the muscularis propria layer

目的 探讨内镜下黏膜下挖除术（ESE）切除胃固有肌层来源的黏膜下肿瘤的手术方式、疗效和安全性.方法 选择2012年2月至2013年4月行胃镜检查发现胃黏膜下隆起病变,超声内镜诊断胃固有肌层来源的黏膜下肿瘤患者53例,均在全身麻醉下行ESE.结果 中位瘤体直径13.2 （5～35）mm.48例患者瘤体成功完全切除,完全切除率90.6％ （48/53）,中位手术时间45（30 ～ 150） min.3例（5.7％,3/53）出现术中搏动性出血,没有术中内镜难以控制的大出血.6例（11.3％,6/53）出现术中穿孔,5例金属夹闭合创面.5例难以剥离和1例穿孔无法修补患者行开腹手术治疗.所有病例均未出现术后穿孔、出血等严重并发症.结论 ESE可以完整切除胃固有肌层来源的黏膜下肿瘤,安全且并发症较少.

Objective To evaluate surgical approach,safety and efficacy of endoscopic submucosal excavation （ESE） for the treatment of gastric submucosal tumors originated from the muscularis propria layer.Methods Fifty-three patients with submucosal tumors of the stomach diagnosed by gastroscope,were examined using endoscopic ultrasonography （EUS） from February 2012 to April 2013.The patients were completed ESE at general anesthesia.Results The diameter of the tumor was from 5 to 35 mm （median 13.2 mm）.The tumors of 48 patients were complete resection,the complete resection rate was 90.6%（48/53）.The operation time was from 30 to 150 min （median 45 min）.Three patients （5.7%,3/53） had impulsivity hemorrhage during ESE,no patients had unmanageable hemorrhea under the gastroscope.Perforation occurred in 6 patients during ESE,perforation rate was 11.3% （6/53）,the perforation was closed by endoclip in 5 patients.Five patients with inability resection and 1 patient with perforation inability closed were treated with surgical operation.None was developed perforation postoperative and hemorrhea.Conclusion ESE is a safety and efficacy method for treating gastric submucosal tumors originating from the muscularis propria layer.