透明帽辅助下套扎切除小胃肠道间质瘤的应用效果

The effect of band ligation assisted by transparent cap on resecting small gastrointestinal stromal tumor

目的探讨透明帽辅助下套扎切除小胃肠道间质瘤(gastrointestinal stromal tumor,GIST)的临床应用价值。方法回顾性分析2017年2月-2020年2月在我院行透明帽辅助下小GIST套扎切除术151例患者的临床资料,分析其完整切除率、复发率、并发症发生率、手术时间、住院天数等指标。结果151例小GIST患者中,瘤体位于胃底91例,胃体53例,胃窦7例,均采用透明帽辅助下完整切除病变。150例病变部位切除后肉眼及病理所见包膜完整无残留,1例分2次套扎后才完全切除肉眼无残留。术中活动性出血3例,无术后迟发性出血,术中主动穿孔105例,穿孔直径最大约1 cm。发生气胸及纵隔气肿3例,局限性腹膜炎3例,发热4例。所有病例经内镜下止血、修补及对症处理后均好转,无1例术中及术后转外科治疗;平均手术时间(28.3±7.6)min,平均住院时间为(4.3±1.9)天。病理结果显示极低危险度胃肠道间质瘤132例,低危险度胃肠道间质瘤19例。术后随访复查胃镜均无复发征象。结论透明帽辅助下套扎切除术胃小GIST操作简单,安全、有效,具有临床推广的价值。

Objective To explore the clinical value of resection of small gastrointestinal stromal tumor(GIST)with transparent cap assisted band ligation.Methods The clinical data of 151 patients who underwent ligation of small GIST assisted with transparent cap in our hospital from February 2017 to February 2020 were retrospectively analyzed,and the complete resection rate,recurrence rate,and complication rate,operation time,hospitalization days and other indicators were analyzed.Results Among the 151 patients with small GIST,91 cases were located in the fundus of the stomach,53 cases were in the stomach body,and 7 cases were in the antrum of the stomach.All the lesions were completely resected with the aid of transparent cap.Among lesions of 150 cases,the envelopes were intact and no residue was seen by naked eyes and pathology examination,and 1 case was completely resected after 2 ligations.There were 3 cases of active bleeding,no delayed bleeding,and 105 cases of iatrogenic perforation during the operation.The maximum diameter of the perforation was about 1 cm.There were 3 cases of pneumothorax and mediastinal emphysema,3 cases of localized peritonitis,and 4 cases of fever.After hemostasis,repair and symptomatic treatment under endoscopy,no case was transferred to surgical departmat during or after operation;the average operation time was(28.3±7.6)minutes,and the average hospital stay was(4.3±1.9)days.Pathological results showed there were 132 cases of very low-risk gastrointestinal stromal tumors and 19 cases of low-risk gastrointestinal stromal tumors.There was no sign of recurrence in the gastroscope during the follow-up.Conclusion The transparent cap assisted ligation resection of small GIST was simple,safe and effective,and had the value of clinical promotion.