摘要
目的探討內鏡下腫瘤切除術治療上消化道間質瘤(gastrointestinal stromal tumors,GIST)的療效及安全性。內鏡下腫瘤切除術包括內鏡黏膜下挖除術(endoscopic submucosal excavation ESE)、內鏡全層切除術(endoscopic full-thickness resection,EFR)及內鏡經黏膜下隧道腫瘤切除術(submucoal tunneling endoscopic resection STER)。方法對2012年9月~2014年6月本院消化科經胃鏡及超聲內鏡或CT診斷的20例來源於胃固有肌層的GIST行內鏡下腫瘤切除術治療。患者使用丙泊酚靜脈注射誘導麻醉。手術標本行免疫組化進一步判定腫瘤性質。觀察腫瘤完整切除率、手術時間、併發症、術後住院時間、術後病理等指標。結果20例中,19例為單發腫瘤,1例為多發(3個)腫瘤。1例位於食管,15例位於胃底,3例位於胃體,2例位於賁門。20個瘤體成功切除20個(100%)。12例(60%)ESE切除,7例(35%)EFR切除,1例(5%)STER切除。平均手術時間為(100.75±73.09)min,手術操作過程中,平均出血量不超過50mL,術後無持續活動性及遲發性出血。術後病理及免疫組化確定間質瘤診斷11例(極低風險間質瘤9例,低風險間質瘤2例),平滑肌瘤7例,顆粒細胞瘤1例,炎症性息肉1例。術後住院時間(4.70±2.36)d。術後隨訪期(4.80±4.49)月。分別1個月、3個月及12個月胃鏡檢查未提示腫瘤殘留及復發。結論內鏡下腫瘤術治療胃腸道間質瘤近期療效安全、可靠,病變可以被完整切除並提供詳細的病理學診斷資料,無嚴重手術相關併發症。
Objective To evaluate the efficacy and safety of endoscopic resection for gastrointestinal stromal tumors(GIST)of upper gastrointestinal tract.Methods From September 2012-June 2014,20 cases of endoscopic tumor resection of gastric GIST originated from muscularis propria diagnosed by endoscopy and endoscopic ultrasonography or CTscan in Kiang Wu Hospital Gastroenterology Department.Propofol is used for intravenous induction of anesthesia.Surgical specimens were sent for immunohistochemistry for further determination of tumor nature.Observe parameters including complete tumor resection rate,operative time,complications,postoperative hospital stay and postoperative pathology.Results 19 cases of solitary tumor,one case of multiple(3)tumors.1ocated in the esophagus,15 in the fundus,3 in the gastric body,2 in the cardia.20 tumors were successfully removed 20(100%).12(60%)by ESE resection,7(35%)by EFR resection,1(5%)by STER resection.The mean operative time was(100.75±73.09)minutes,the average amount of bleeding was less than 50ml,there was no sustained activity and delayed bleeding.The pathological and immunohistochemical showed:11(9 very low risk stromal tumor,2 low-risk stromal tumors),7 diagnosis as leiomyoma,1 diagnosed as granular cell tumor,1 diagnosis as inflammatory polyps.Postoperative hospital stay(4.70±2.36)days.Postoperative follow-up period(4.80±4.49)months.One month,three months and 12 months endoscopy did not show residual tumor and recurrence.Conclusion Endoscopic treatment of gastrointestinal stromal tumors are safe with short-term efficacy,reliable,and complete resection of the lesion can be achieved with detailed pathological diagnosis,without serious procedure-related complications.
作者
梁棋
朱雪茵
王文棟
余漢濠
李清麗
李婺芳
LEUNG Ki;ZHU Xue Yin;WANG Wen Dong;YU Hon Ho;LEI Qing Li;LI Mo Fong(Department of Gastroenterology,Kiang Wu Hospital,Macao,China)
出处
《镜湖医学》
2014年第2期54-57,F0003,共5页
MEDICAL JOURNAL OF KIANG WU
关键词
內鏡黏膜下挖除術
內鏡全層切除術
內鏡經黏膜下隧道腫瘤切除術
胃腸道間質瘤
Endoscopic submucosal excavation
Endoscopic full-thickness resection
Submucoal tunneling endoscopic resection
Gastrointestinal stromal tumors
