内镜全层切除术在34例胃固有肌层肿瘤治疗中的应用

Application of endoscopic full-thickness resection in the treatment of gastric tumors originated from the muscularis propria

目的：探讨内镜全层切除术（endoscopic full-thickness resection,EFR）在胃固有肌层肿瘤治疗中的疗效及安全性。方法：自2012年11月至2014年8月对中南大学湘雅三医院收治的34例胃固有肌层肿瘤患者进行EFR治疗,评价肿瘤切除率、并发症发生及肿瘤复发情况。结果：34例胃固有肌层肿瘤患者中男15例,女19例,年龄38.3-70.6（52.3±4.3）岁。肿瘤位于胃底者25例,胃体者9例。34例固有肌层肿瘤均经EFR完整切除,完整切除率100%,无1例转手术治疗。肿瘤直径1.0-5.0（2.8±1.2）cm;EFR完成时间为50-100（76.5±18.2）min。气腹患者行腹腔穿刺排气缓解;无术后出血、穿孔等并发症。患者住院时间3-5（3.6±0.8）d。术后病理结果显示除1例胃体后壁瘤体为胰腺组织外,其余33例均为梭形细胞肿瘤,免疫组织化学符合间质瘤（2例为中度侵袭危险,31例为极低度、低度侵袭危险性。2例近贲门口病变具有平滑肌分化倾向）。34例患者随访时间5-23个月,无复发或转移。结论：EFR是治疗胃固有肌层肿瘤的一种安全、有效的微创方法。

Objective： To evaluate the curative eff ect and safety of endoscopic full-thickness resection（EFR） in the treatment of gastric tumor originated from the muscularis propria.Methods： Clinical data were collected from 34 patients, who underwent EFR of gastric tumor originated from muscularis propria, to observe the resection rate and complications from November 2012 to August 2014.Results： Of the 34 patients, 15 were male, 19 were female, with the age of 38.3-70.6（52.3±4.3）years old. The lesions of 25 patients located in the fundus of stomach and the rest was in the gastric body. EFR was successfully performed in the 34 patients with no need for surgery. The complete resection rate was 100%. Lesion diameter ranged from 1.0 to 5.0（2.8±1.2） centimeters. The operation time was 50-100（76.5±18.2） min. Patients with pneumoperitoneum were relieved after abdominal puncture exhaust, without post-operation bleeding and perforation. The hospitalization duration was 3-5（3.6±0.8） days. Except 1 case, the remaining 33 cases were spindle cell tumors, consistent with the results of immunohistochemistry. The risk for two lesions with 4.5 cm and 5.0 cm was moderate. The risk of invasion was low or very low in the remaining 31 cases. Among them, 2 stromal tumors near the cardia showed a differentiation tendency toward smooth muscle. No lesion residual or recurrence happened during the follow-up period（range 5-23 months） in 34 cases. Conclusion： EFR is a safe and effective method for gastric tumor originated from muscularis propria.