内镜黏膜下剥离术及其衍生术在治疗胃黏膜下肿瘤中的应用

Application of endoscopic submucosal dissection and its derivative technology in treatment of patients with gastric submucosal tumor

目的探讨内镜黏膜下剥离术（ESD）及其衍生技术在治疗胃黏膜下肿瘤（SMT）中的安全性和有效性。方法回顾性分析接受内镜治疗的胃SMT患者的临床资料。结果 52例胃SMT患者中,肿瘤位于黏膜肌层5例,黏膜下层10例,固有肌层37例。病变直径为（0.8±0.1）cm。32例接受ESD,13例接受内镜下黏膜挖除术（ESE）,7例接受内镜下消化道壁全层切除术（EFE）,6例内镜治疗失败转手术治疗,成功率为88.5%。术中穿孔3例,出血2例,贲门黏膜撕裂1例;术后迟发性出血2例。EFR组均将瘤体及其相连的固有肌层和浆膜层切除,并在内镜下完全缝合胃壁缺损。52例患者术后均接受2~22月随访,无局部复发及远处转移病例。结论 ESD是一种安全和有效的胃SMT治疗手段。

Objective To explore the safety and efficacy of endoscopic submucosal dissection（ ESD） and its derivative technology in the treatment of patients with gastric submucosal tumor（ SMT）. Methods Clinical materials of gastric SMT patients treated by endoscopic therapy were analyzed retrospectively. Results Of 52 patients with gastric SMT,the tumors of 5 cases were located in muscularis mucosa,10 cases were located in submucosal layer,and 37 cases were located in muscularis propia. Diameter of lesions were（ 0. 8 ±0. 1） cm. Thirty-two patients were treated by（ ESD）,thirteen patients were treated by endoscopic submucosal excavation（ ESE）,and seven patients were treated by endoscopic full-thickness resection（ EFR）. Six patients had surgeries due to failure of endoscopic treatment,and the success rate of treatment was 88. 5%. Complications were various,including 3 cases of intraoperative perforation,2 cases of intraoperative hemorrhage,one case of cardiac mucosal laceration and 2 cases of postoperative delayed hemorrhage. Patients in EFR group were treated with resections of tumor and its connected muscularis propria and serosa. All of 52 patients were followed up for 2 to 22 months,and no local recurrence and distant metastasis were observed. Conclusion ESD is a safe and effective therapeutic method for gastric SMT.