内镜下全层切除术联合OTSC吻合系统在治疗胃间质瘤中的应用研究

Application of endoscopic full-thickness resection combined with OTSC clipping system in the treatment of gastric stromal tumors

目的探究内镜下全层切除术(EFTR)联合OTSC吻合系统治疗胃间质瘤的安全性及有效性。方法回顾性分析2016年9月至2018年10月经宁夏回族自治区人民医院行EFTR联合OTSC夹闭系统治疗胃间质瘤24例临床资料。结果 24例患者中,成功切除率及闭合率为100%,闭合穿孔直径最小为0.3 cm×0.3 cm,闭合穿孔直径最大为4.3 cm×3.8 cm,平均(2.5±1.5)cm,术中有少量渗血,均予以氩离子凝固术(APC)电凝止血,平均操作时间(45±60)min,术后平均住院时间为(3±5)d。术后无气胸、发热,无发生迟发性出血、消化道瘘、继发性胸腹腔感染及其它严重并发症。术后第1、3、6个月随访复查胃镜,观察创面愈合情况,病变均无复发现象,24例病理提示梭形细胞肿瘤及结合免疫组织化学诊断为间质瘤,位于胃底、胃窦及胃体;均为极低度、低度侵袭危险性,建议患者定期复查胃镜。结论 EFTR联合OTSC吻合系统治疗胃间质瘤是一种安全、有效的技术,值得在临床上推广使用。

Objective To investigate the safety and efficacy of endoscopic full-thickness resection combined with OTSC anastomosis system in the treatment of gastric stromal tumors.MethodsRetrospective analysis of clinical data of 24 patients with gastric stromal tumor treated by endoscopic full-thickness resection combined with OTSC clipping system in our hospital from September 2016 to October 2018.Results Among 24 patients who underwent total endoscopic resection combined with OTSC metal clip system suture,the successful resection rate and closure rate were 100%,the minimum diameter of closed perforation was 0.3 cm×0.3 cm,the maximum diameter of closed perforation was 4.3 cm×3.8 cm,the average size was(2.5±1.5)cm,and a small amount of bleeding during the operation was coagulated by APC electrocoagulation.The average operation time was(45±60)minutes,and the average hospitalization time after operation was(4.3 cm×3.8 cm).No pneumothorax,fever,delayed hemorrhage,digestive tract fistula,secondary thoraco-abdominal infection and other serious complications occurred after operation.The patients were followed up for gastroscopy at 1,3 and 6 months after operation.No recurrence was observed in wound healing and pathological changes.24 patients with spindle cell tumors were diagnosed by pathology and immunohistochemistry as stromal tumors located in the fundus,antrum and body of stomach.And 24 cases of stromal tumors were of very low and low invasive risk.It is suggested that patients should review gastroscopy regularly.ConclusionEndoscopic full-thickness resection combined with OTSC anastomosis system is a safe and effective technique for the treatment of gastric stromal tumors.It is worthy of clinical use.