65例胃黏膜下病变超声诊断及微创治疗的临床分析

Clinical analysis of ultrasound diagnosis and minimally invasive treatment of 65 cases of gastric submucosal lesions

目的探讨超声胃镜在胃黏膜下病变诊断及治疗中的指导作用及治疗方式的选择。方法回顾性分析2010年1月至2013年12月经胃镜及超声胃镜联合初步诊断为胃黏膜下病变65例患者的临床资料。结果 3组患者手术时间比较,差异无统计学意义(P>0.05)。内镜治疗组患者术后住院天数和术后肛门通气时间,均显著短于腹腔镜治疗组和开腹手术组患者,差异有统计学意义(P<0.05)。腹腔镜治疗组患者术后住院天数显著短于开腹手术组患者,差异有统计学意义(P<0.05),但术后肛门通气时间与开腹手术组患者比较,差异无统计学意义(P>0.05)。2例内镜治疗组患者在行ESD及EMR后发生穿孔,后转至普外科开腹手术,痊愈出院。结论超声胃镜诊断胃黏膜下病变符合率高,起源于黏膜肌层或黏膜下层的胃黏膜下病变,如病灶<2.0 cm,建议在内镜下微创治疗,创伤小、恢复快,但手术安全性稍差;如病灶>2.0 cm或起源于固有肌层,则建议行腹腔镜下微创治疗或开腹手术,其中双镜联合技术(LECS)成为胃黏膜下病变治疗新的趋势。

Objective To explore the guiding role of ultrasonic gastroscope in the diagnosis and treatment of gastric submucosal lesions as well as the choice of the treatment of gastric submucosal lesions. Methods Retrospectively analyzed the clinical datas of 65 cases gastric submucosal lesions which diagnosed by menstrual gastroscope and endoscopic uhrasonography during January 2010 to December 2013. Results The difference of operation time among the three treatment groups were not statistically significant （ P 〉 0. 05 ）. Postoperative hospital stay and postoperative anus ventilation time in endoscopic treatment group were significantly shorter than the laparoscopic group and laparotomy group, the difference was statistically significant （P〈 0. 05）. The postoperative hospital stay of laparoscopic group was significantly shorter than the laparotomy group, the difference was statistically significant （P〈0. 05）. But the difference was postoperative anus ventilation time was not statistically significant （P〉0.05）. 2 cases of perforation occurred in endoscopic treatment group after ESD and EMR, later transferred to the Department of general surgery laparotomy, cured and discharged.Conclusions The compliance rate of ultrasonography in the diagnosis of gastric mucosal lesions is high. Gastric mucosal lesions those originated in the mucosal muscle layer or the submucosal, if the lesions less than 2.0cm, endoscopic minimally invasive treatment is suggested, this method with small trauma and recovery quickly, but the operation safety is slightly worse. When lesions over 2.0cm or originating from the muscular propria layer, it is recommended that laparoscopic minimally invasive treatment or laparotomy. In which laparoscopic and endoscopic cooper-active surgery （LECS） has become a new trend in the treatment of gastric submucosal lesions.