超声内镜辅助下皮圈套扎术对胃间质瘤的治疗价值

Endoscopic ultrasonography-assisted band ligation in small gastric stromal tumors

目的：探讨超声内镜辅助下橡皮圈套扎术对胃间质瘤的治疗价值。方法回顾性分析郑州大学人民医院（河南省人民医院）内镜中心自2011年10月至2013年12月收治胃固有肌层源性间质瘤患者120例（间质瘤大小5～12 mm），行内镜下橡皮圈套扎治疗。治愈标准为病变完全脱落，如未脱落或仅有部分脱落则认为无效，给予重复治疗。术前、术中和术后行常规内镜及超声内镜（EUS）检查、随访。结果一次套扎成功116例（96．7％），2例二次套扎成功，2例放弃内镜治疗。7例患者术后3 d 内出现一过性少量黑便，未经特殊处理症状消失，无穿孔、大出血等严重并发症发生。120例患者全部进行3～49个月的随访，2例患者术后2年局部息肉样增生，再次内镜下切除；118例患者完全治愈，未见复发。结论超声内镜辅助下橡皮圈套扎术治疗胃固有肌层间质瘤（大小5～12 mm）安全有效，临床可行性好。

Objective To discuss the safety and efficacy of endoscopic ultrasonography （EUS）-assisted band ligation in the resection of gastrointestinal stromal tumor （GIST）.Methods A retrospective study was conducted on 120 patients with small gastric stromal tumors originating from the gastric muscularis propria （the diameters of tumors ranging from 5 to 12 mm）who underwent EUS-assisted band ligation at Zhengzhou University Affiliated People′s Hospital（Henan Provincial People′s Hospital）in the period from October 2011 to December 2013.The criterion of cure was complete sloughing of tumor.The conventional endoscopic examination and EUS were carried out before,during and after operation respectively,and the patients were followed up after operation.Results A hundred and sixteen GISTs sloughed completely once and for all （96.7%）;2 cases were ligated at the second time and sloughed completely,and the rest 2 patients gave up the second endoscopic band ligation.Transient bleeding occurred in 7 patients within 3 days after ligation and disappeared spontaneously without special management.No perforation,hemorrhage or other severe complications occurred.All the patients were followed up for a period from 3 to 49 months. During the follow-up,local polypoid proliferation were observed in 2 patients and resected under endoscope;no recurrence occurred in the rest 118 patients.Conclusion Endoscopic band ligation under EUS guidance is an effective and safe treatment for gastric GISTs in the size from 5 mm to 12 mm.