改良ESD联合橡皮圈套扎切除胃小脂肪瘤的疗效和安全性

Efficacy and safety of modified ESD and rubber band ligation assisted endoscopic dissection for treatment of small gastric lipomas

目的探讨改良内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)联合橡皮圈套扎切除胃小脂肪瘤的疗效和安全性。方法选择经超声内镜明确肿物(6 mm≤长径≤13 mm)来源于胃黏膜下层的37例患者,在对患者实施静脉麻醉下,先采用改良ESD剥离小肿物,暴露到一定程度后,采用橡皮圈套扎肿物,然后进行圈套器套扎切除。观察术中出血、穿孔情况,观察肿物切除的完整性、标本大小,对标本进行病理组织学检查,术后对患者进行6及12个月的胃镜及EUS随访。结果 37例胃小脂肪瘤均一次完整切除,手术操作时间(12.6±2.5)min,术中平均出血量<2 ml,术中无穿孔,术后观察1周均无迟发性出血、穿孔等情况发生;标本大小5 mm×6 mm^12 cm×13 mm,术后病理诊断均为胃脂肪瘤;术后随访12个月,均未见残留、复发等情况。结论改良ESD联合橡皮圈套扎切除治疗胃小脂肪瘤的疗效确切、安全,可完整切除病变,获取完整的病理学诊断资料,弥补了单纯套扎治疗或单纯高频电圈套切除等内镜治疗方法的不足。

Objective To investigate the efficacy and safety of modified endoscopic submucosal dissection（ ESD） and rubber band ligation assisted endoscopic dissection for treatment of small gastric lipomas. Methods A total of thirty-seven patients who were diagnosed with gastric lipomas（ 6 mm≤diameter≤13 mm） originating from the submucosa layer by EUS in our hospital were enrolled in this study. With intravenous anesthesia in all the patients,modified ESD was performed first to stripe the small tumors. After exposure to some extent,the tumors were ligated by rubber band and snared for endoscopic dissection. Bleeding,intraoperative and postoperative perforation,the integrity and size of the resected specimens were observed and recorded. The resected specimens were identified with hystopathological examination. Six and twelve months after the operation,all the patients were reviewed by gastroscopy and EUS in our hospital. Results All the thirty-seven tumors were resected completely and successfully. The mean operating time was（ 12. 6 ±2. 5） min,the intraoperative blood loss was less than 2 ml,and there was no case of intraoperative perforation. No delayed bleeding or perforation occurred one week after operation. The tumor size ranged from 5 mm × 6 mm to 12 mm × 13 mm. Thirty-seven gastric lipomas were identified in postoperative pathology. There were no residues or recurrence in any of these cases during the follow-up period of12 months. Conclusions Modified ESD and rubber band ligation assisted endoscopic dissection for treatment of small gastric lipomas are effective and safe. Tumors can be resected completely. Complete data on pathological diagnosis can become available. This approach can make up for the deficiency of endoscopic treatment methods.