内镜下黏膜剥离术治疗胃底黏膜下肿瘤疗效评价

Efficacy of endoscopic submucosal dissection in treatment of gastric fundus submucous tumors

目的探讨内镜下黏膜剥离术（endoscopic submucosal dissection,ESD）治疗胃底黏膜下肿瘤的可行性及疗效。方法对2012年5月-2013年10月胃镜检查发现的15例胃底黏膜下占位病灶行ESD治疗,对内镜治疗效果进行评价。结果 13例均一次性顺利剥离,ESD操作时间35～100 min,平均60.4 min;1例来源于固有肌层因与浆膜层粘连广泛穿孔后无法继续剥离转外科急诊手术;1例剥离中发现微穿孔,予金属夹缝合创面,留置胃肠减压,术后予以禁食、抗炎、制酸、止血等治疗,内科保守治疗成功。术中创面均有少量出血,平均出血量约20 ml,均无迟发性出血及穿孔。术后病理诊断：10例为间质瘤,4例为平滑肌瘤,1例为脂肪瘤。患者接受随访3～12个月,未见病灶残留和复发。结论 ESD治疗胃底黏膜下肿瘤可行有效,胃底黏膜下肿瘤术后病理多为间质瘤,应早期治疗和术后密切随访。

Objective To investigate the feasibility and efficacy of endoscopic submucosal dissection（ ESD） in treatment of gastric fundus submucous tumors. Methods A total of 15 patients confirmed with submucous tumors in gastric fundus from May. 2012 to Oct. 2013 were treated by ESD,and the effect of endoscopic treatment was evaluated.Results Thirteen cases were successfully stripped one time,the ESD operation time was 35 ～ 100 min（ mean 60. 4min）. One case of perforation underwent emergency surgery because of originated in the muscularis propria,serosa adhesions extensively. One case was found stripped micro perforation,which was closed with endoclip,indwelling decompression,fasting,anti-inflammatory,acid suppression,stop bleeding and other treatments,conservative treatment was successful. Intraoperative bleeding wounds had small amount of bleading（ average 20 ml）,no delayed bleeding and perforation occurred. Pathological findings 10 cases of gastrointestinal stromal tumors and 4 cases of leiomyoma,1 case of lipoma. Patients were followed up for 3 to 12 months,no residual disease and relapse occurred. Conclusion ESD is a feasible and effective endoscopic procedure to remove gastric fundus submucous tumors. And pathology of gastric submucosal tumors are mostly stromal tumors,early treatment and surgery should be closely followed up.