内镜下胃全层切除术治疗不同大小胃黏膜下肿瘤的疗效及安全性

Efficacy and safety of endoscopic full-thickness gastrectomy in the treatment of different sizes of gastric submucosal tumors

目的探讨内镜下胃全层切除术在治疗不同大小的胃黏膜下肿瘤的可行性、安全性,为临床内镜治疗提供可靠科学依据。方法回顾31例胃黏膜下肿瘤的住院患者临床资料,均采用内镜下胃全层切除术+金属钛夹或尼龙绳联合钛夹荷包缝合夹闭创面,分析并比较不同肿瘤大小(直径≤10 mm、11~20 mm、>20 mm)患者间的手术情况、术后并发症、术后恢复及随访情况。结果所有病例均完整切除病灶和有效缝合创面,肿瘤直径>20 mm组手术时间、鼻胃管留置时间、开放饮食时间、住院时间和住院费用均多于其他2组,差异有统计学意义(均P<0.05),而3组间的并发症发生率差异无统计学意义(P>0.05)。肿瘤直径>20 mm组术后血红蛋白下降(17.00±8.25)g/L,与肿瘤直径≤10 mm组和11~20 mm组比较差异有统计学意义(F=4.680,P=0.019)。结论内镜下胃全层切除术可用于不同肿瘤大小的胃黏膜下肿瘤切除,其微创、安全及快速康复的特点可广泛应用于临床治疗。

Objective To explore the feasibility and safety of endoscopic full-thickness gastrectomy in treating different sizes of gastric submucosal tumors to provide a reliable scientific basis for clinical endoscopic treatment.Methods The clinical data of 31 hospitalized patients with gastric submucosal tumors were reviewed.Endoscopic full-thickness gastrectomy+titanium clip or nylon rope combined with titanium clip purse were used to clamp the wound.The operation,postoperative complications,postoperative recovery,and follow-up of patients with different tumor sizes(diameter≤10 mm,11-20 mm,>20 mm)were analyzed and compared.Results All cases underwent complete resection of the focus and effective suture of the wound.The operation time,nasogastric tube retention time,open diet time,hospitalization time,and hospitalization expenses of the tumor diameter>20 mm group were more than those of the other two groups,with statistically significant differences(all P<0.05).However,there was no statistically significant difference in the incidence of complications among the three groups(P>0.05).The hemoglobin in the group with tumor diameter>20 mm decreased by(17.00±8.25)g/L after the operation,which was statistically significant compared with the group with tumor diameter≤10 mm and 11-20 mm(F=4.680,P=0.019).Conclusions Endoscopic full-thickness gastrectomy can be used to resect gastric submucosal tumors with different tumor sizes.Its minimally invasive,safe,and rapid rehabilitation characteristics can be widely used in clinical treatment.