内镜下套扎器联合圈套器在胃底黏膜下微小肿瘤治疗中的应用效果

Application of endoscopicligator combined with snare in the treatment of submucosal micro tumors of the gastric fundus

目的探讨内镜下套扎器联合圈套器在胃底黏膜下微小肿瘤治疗中的应用效果。方法选取2016年3月至2020年12月于梅州市人民医院检查并择期行手术治疗的93例胃底黏膜下微小肿瘤患者,按手术方式的不同分为观察组(36例)与对照组(57例)。观察组采用套扎器联合圈套器辅助的内镜下黏膜切除术治疗,对照组采用常规内镜下黏膜剥离术治疗,术后均给予质子泵抑制剂(PPI)、抗生素、抑酸等常规治疗,并于术后3个月复查胃镜。记录两组患者的手术时间、术中出血量及术中穿孔情况,比较两组肿瘤完整切除率、切缘阳性率及术后并发症发生率,评估两组术后创面愈合情况。结果观察组手术时间较对照组更短[(30.68±5.74)min vs.(42.79±7.31)min],术中出血量较对照组更少[(2.11±0.54)ml vs.(3.65±0.67)ml],差异有统计学意义(P<0.05),两组术中穿孔率、肿瘤完整切除率、切缘阳性率差异均无统计学意义(P>0.05)。术后3个月复查胃镜,观察组创面愈合良好,见白色瘢痕,对照组溃疡1例,钛夹残留2例,其余患者创面瘢痕愈合良好,随访期间两组均无复发。观察组术后并发症发生率较对照组降低(16.67%vs.36.84%,P<0.05)。结论内镜下套扎器联合圈套器应用于胃底黏膜下微小肿瘤的治疗简化了手术程序,缩短了手术时间和患者住院时间,肿瘤完全切除率高,安全性佳。

Objective To explore the application of endoscopic ligator combined with snare in the treatment of submucosal micro tumors of the gastric fundus.Methods A total of 93 patients with gastric fundus submucosal microtumor who were examined in Meizhou People s Hospital from March 2016 to December 2020 and underwent elective surgery were selected,according to different surgical methods,they were divided into observation group(36 cases)and control group(57 cases).The observation group was treated with endoscopic mucosal resection assisted by ligature and snare,while the control group was treated with conventional endoscopic submucosal dissection,all patients were given conventional treatment such as proton pump inhibitor(PPI),antibiotics and acid suppression after operation,and gastroscopy was performed at the 3rd months after operation.The operation time,intraoperative blood loss and intraoperative perforation of the two groups were recorded,the complete tumor resection rate,the positive rate of incision margin and the postoperative complications rate were compared between the two groups,and the postoperative wound healing of the two groups was evaluated.Results The operation time of the observation group was shorter than that of the control group[(30.68±5.74)min vs.(42.79±7.31)min],the intraoperative blood loss was less than that of the control group[(2.11±0.54)ml vs.(3.65±0.67)ml],the difference was statistically significant(P<0.05),There was no significant difference in intraoperative perforation,complete tumor resection rate and positive rate of resection margin between the two groups(P>0.05).Gastroscope re-examination at the third month after surgery showed that the wounds in the observation group healed well with white scars,in the control group,there was 1 case of ulcers and 2 cases of residual titanium clips,and the scars in the other patients healed well,there was no recurrence in both groups during the follow-up period.The incidence of postoperative complications in the observation group was lower than that in the control group(16.67%vs.36.84%,P<0.05).Conclusions The endoscopic ligator combined with snare simplifies the operation procedure when applied to the treatment of submucosal micro tumor of gastric fundus,which can shorten the operation time and hospitalization time,and has high tumor resection rate and good safety.