内镜下透明帽法黏膜切除术在上消化道黏膜下肿瘤切除中的临床应用

Clinical application of Endoscopic hyaline cap mucosal resection in the treatment of upper gastrointestinal submucosal tumors

目的观察内镜下透明帽法黏膜切除术在上消化道黏膜下肿瘤切除中的应用价值。方法通过回顾性分析2014年1—12月间来我院消化内镜中心诊断的黏膜下肿瘤,并进行透明帽法黏膜下切除术。结果 86例患者肿瘤部位与病理性质结果为食管35例,胃32例,十二指肠19例;平滑肌瘤42例、间质瘤15例、类癌3例、脂肪瘤5例、布氏腺瘤12例、淋巴结1例、异位胰腺8例;肿瘤大小1.5~2.0 cm10例、1.0~1.5 cm70例、〈1.0 cm6例。并发急性出血患者11例、无迟发性出血、无急性及迟发性穿孔;术中发现残留者6例。所有的患者均在术后3个月后复查均无复发及残留。内镜下透明帽法黏膜切除术在上消化道黏膜下肿瘤切除中有效率100%,一次性切除率93.02%,并发急性出血12.79%,但出血量小（5~10ml）。结论透明帽法黏膜切除术在上消化道黏膜下肿瘤（〈2.0cm）切除中安全、快速、有效。内镜下透明帽法黏膜切除术在上消化道黏膜下肿瘤切除中值得在无超声内镜设备的基层医院推广应用。

Objective Observe the value of endoscopic hyaline cap mucosal resection in the treatment of upper gastrointestinal submucosal tumors. Methods Retrospectively analyzed the datas of 86 patients who were diagnosed as submucosal tumor in digestive endoscopy center of our hospital during January 2014 and December 2006, and they received transparent cap mucosa resection. Among the patients, including 35 cases of esophageal tumor, 32 cases of stomach tumor, duodenum occurred in 19 cases. According to the tumor type, there were 41 cases of Leiomyoma, 15 cases of interstitialoma, 3 cases of resemble cancer, 5 cases of lipoma, 13 cases of adenoma, 1 cases of lymph nodes tumor, 8 cases of ectopic pancreas. Tumor size 1.5cm -2.0cm in 10 cases, 1. 0cm - 1.5cm in 70 cases, less than 1.0cm in 6 cases. There were 11 cases of patients with acute hemorrhage, 0 cases of delayed bleeding, no acute and delayed perforation. There were 6 cases found residual in the operation. All patients had no recurrence and residual 3 months after operation. Results The total effective rate of endoscopic mucosal resection of the upper gastrointestinal submucosal tumor was 100%, the rate of one time resection was 93.02%, and 12.79% of the patients suffered acute hemorrhage, but the amount of bleeding was small （5ml - 10ml）. Mucosal resection of the upper gastrointestinal submucosal tumor （ 〈 2.0cm） was safe and fast. Conclusions Endoscopic hyaline cap mucosal resection in the treatment of upper gastrointestinal submueosal tumor is worthy of application in the primary hospital.