内镜全层切除术治疗胃底部小及微小胃肠间质瘤价值探讨

Therapeutic value of endoscopic full-thickness resection for small gastrointestinal stromal tumor in the fundus of stomach

目的探讨内镜全层切除术(EFTR)治疗胃底部小及微小(直径<2 cm)的胃肠间质瘤的安全性和有效性。方法回顾性分析2013年1月至2015年12月复旦大学附属中山医院内镜中心行EFTR治疗胃底部小及微小(直径<2 cm)胃肠间质瘤131例病人的临床资料,观察术后并发症发生情况以及随访期间肿瘤复发转移情况。结果 131例病人经术前超声内镜检查示14例(10.7%)具有胃肠间质瘤高风险特征,病变直径为1.0(0.2~1.7)cm;EFTR整块切除122例,整块切除率为93.1%,非整块切除病灶经行再次切除后均全部切除;中位手术时间为30(10~113)min,19.1%(25/131)手术时间≥60 min,术中未发生较大量的出血,亦无中转手术的病例,术后住院时间为4(1~12)d。1例(0.8%)在术后出现明显气腹,使用20G穿刺针进行减压治疗后好转;1例(0.8%)在术后出现胸腔积液伴发热及局部肺不张,经胸腔闭式引流治疗后好转;术后4例(3.1%)病人发生电凝综合征,予以禁食、输液、静脉使用抗生素等保守治疗后好转。对于非完整切除和具有超声内镜高风险特征的病灶的病人,未实施外科手术及放化疗等追加治疗,而是密切随访。术后随访时间为33(18~54)个月,未见复发和远处转移。结论直径<2 cm的胃部胃肠间质瘤在病人有意愿治疗的情况下应尽早行内镜下切除治疗,而EFTR治疗位于胃底部的胃肠间质瘤虽然有一定技术难度,但安全有效。

Objective To evaluate the safety and efficacy of endoscopic full-thickness resection （EFrR） in the treatment of small gastrointestinal stromal tumors （〈2cm） in the fundus of stomach. Methods The clinical data of 131 patients with small gastrointestinal stromal tumors （〈2cm） in the fundus of stomach underwent EFFR from January 2013 to December 2015 in Endoscopy Center, Zhongshan Hospital, Fudan University were analyzed retrospectively. The incidence rate of complications after EFTR and results of recurrence or metastasis during the follow-up period were analyzed retrospectively. Results Among~ 131 patients, 14 patients （10.7%） had high risk EUS features of gastrointestinal stromal tumors. The lesion diameter ranged from 0.2 to 1.7 （median 1.0 cm）.One hundred and twenty-two cases obtained successful complete resection, the complete resection rate was 93.1%, those failed were treated again after resection were excised; median operative time was 30 （10-113） min, 19.1% （25/131） patients＇operation time was greater than 60 rain.There was no significant hemorrhage in the operation, and no cases of transfer surgery were performed. The postoperative hospital stay was 4 （1-12） d. One patient （0.8%） had serious pneumoperitoneum, who was treated by decompression with 20G puncture needle. One patient （0.8%） had a pleural effusion with fever and local atelectasis after surgery, who was improved after thoracic closed drainage. Four patients （3.1%） with electrocoagulation syndrome were treated by fasting, infusion, intravenous use of antibiotics and other conservative treatment. For lesions which were not resected completely or had high risk features of EUS, additional treatments, such as surgery, radiotherapy or chemotherapy, were not performed but with close follow-up. The follow-up time was 18 to 54 months （median 33）, without recurrence and distant metastasis occurred. Conclusion Small stomach gastrointestinal stromal tumors （〈 2 cm） should be treated as early as possible when patients want to be treated through endoscopic resection. Although there are some technical difficulties in treatment of stromal tumors in the fundus of the stomach by EFTR, safety and effectiveness are positive.