内镜下橡皮圈联合尼龙绳结扎剥离术治疗胃固有肌层小肿瘤临床价值分析

Rubber band and nylon loop assisted endoscopic dissection for treatment of small gastric submucosal tumors originating from the muscularis propria layer

目的探讨内镜下应用橡皮圈联合尼龙绳结扎剥离的方法治疗胃固有肌层来源小肿瘤的安全性、有效性和可行性。方法选择36例经超声内镜(EUS)明确肿瘤(长径≤12 mm)来源于胃固有肌层的患者,在内镜下先用橡皮圈套扎,而后使用尼龙绳在橡皮圈的底侧进行结扎,然后进行剥离治疗,记录术中术后出血、穿孔情况及标本大小,对切除物行病理免疫组织化学检查,并于术后3、6及12个月进行胃镜复查及EUS随访。结果36例病变均一次性完整剥离,手术平均操作时间(15±2)min,术中出血量<2 ml,标本大小5 mm×6 mm^10 mm×11 mm,术后无出血及穿孔发生,术后病理免疫组化确诊胃平滑肌瘤10例,胃间质瘤26例(危险度分级:均为极低)。术后随访12个月,所有病例未见复发及转移。结论内镜下应用橡皮圈联合尼龙绳结扎剥离的方法治疗胃固有肌层来源的肿瘤显示了一定的安全性、有效性和可行性,但尚需要进行大规模临床研究及长期随访进一步明确其治疗价值。

【Objective】To evaluate the clinical efficacy,safty, and technical feasibility of rubber band and nylon loop assisted endoscopic dissection for treatment of small gastric submucosal tumors originating from the muscularis propria layer.【Methods】A total of 36 patients who were diagnosed as gastric SMT（diameter ≤12 mm） originating from the muscularis propria layer by EUS in our hospital were enrolled in this study, rubber band ligation and nylon loop were performed for assisting endoscopic dissection in all patients, the situation of bleeding/perforation in both intraoperative and postoperative and the size of the resected specimens were recorded, all the tumors enucleated were identified with hystopathological exam and immunohistochemistry. At the months 3,6 and 12, 36 patients were reviewed by gastroscopy and EUS in our hospital.【Results】All the 36 tumors were enucleated completely and successfully, the mean operating time was 15 min（range 13~17 min）, the blood loss in operation was less than 2 ml, tumor sizes ranged from 5×6 mm to 10×11 mm, with regard to complication, neither of postoperative hemorrhage and perforation occurred. 10 gastric leiomyomas, 26 gastric stromal tumors（Risk classification： all were very low risk）were identified. And there were no recurrence or metastasis in all the cases during the follow-up period.【Conclusion】To a certain extent, rubber band and nylon loop assisted endoscopic dissection for treatment of small gastric submucosal tumors originating from the muscularis propria layer shows its clinical efficacy, safety, and technical feasibility, but it still requires extensive clinical studies and long term follow-up to further clarify its therapeutic value.