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目的探讨内镜黏膜下挖除术在胃胃肠道间质瘤治疗中的安全性及有效性。方法回顾性分析第三军医大学大坪医院消化内科2009年10月至2012年12月58例确诊为胃肠道间质瘤行内镜黏膜下挖除术治疗的患者资料,包括患者的基本情况、病变部位、大小、治疗经过以及病理结果等,统计并发症发生及术后随访情况。结果 58例患者均顺利完成内镜黏膜下挖除术治疗,病变直径在5~30 mm,均一次性完整切除病变,手术时间(自黏膜下注射开始至完整剥离病变的时间)40~135 min,平均(51.7±14.2)min,术中创面均有不同程度出血,出血量约5~200 ml,经氩离子凝固术、电活检钳凝固术或金属夹闭合创面止血成功,有7例术中并发穿孔,穿孔发生率12%(7/58),应用金属夹夹闭缝合穿孔,腹腔穿刺抽气,术后给予胃肠减压、质子泵抑制剂抑酸、抗炎等治疗。58例患者均无术后出血。内镜黏膜下挖除术治疗后住院5~14 d,平均(7.5±1.4)d,穿孔患者术后1个月胃镜复查见穿孔均闭合,所有患者接受随访3~26个月,未见病变残留和复发。结论内镜黏膜下挖除术治疗直径小于30 mm、腔内生长为主的胃胃肠道间质瘤是一种安全、有效、创伤小的治疗方法。
Objective To investigate the safety and efficacy of endoscopic submucosal excavation in the treatment of gastrointestinal stromal tumors. Methods A retrospective analysis of 58 patients diagnosed as gastrointestinal stromal tumors undergoing endoscopic submucosal excavation from October 2009 to December 2012 in Department of Gastroenterology, Daping Hospital, Third Military Medical University was retrospectively analyzed. The data including patient’s basic information, Lesion, size, treatment and pathological results, statistical complications and postoperative follow-up. Results All the 58 patients successfully completed the endoscopic submucosal excavation. The diameter of the lesion ranged from 5 to 30 mm. All the lesions were completely removed at one time. The operation time (the time from the beginning of submucosal injection to complete dissection) was 40 to 135 minutes , With an average of (51.7 ± 14.2) min. All wounds were bleeding to varying degrees and the amount of bleeding was about 5 ~ 200 ml. After argon ion coagulation, electrocoagulation and coagulation or metal clip closure, The incidence of perforation and perforation was 12% (7/58). Metal clips were used to close the suture and perforation. Abdominal puncture and aspiration were performed. Postoperative gastrointestinal decompression and proton pump inhibitors were used to inhibit acid and anti-inflammatory. None of the 58 patients had postoperative bleeding. Endoscopic submucosal excavation after treatment for 5 to 14 days, an average of (7.5 ± 1.4) d, perforation patients 1 month after gastroscopy review see perforation were closed, all patients were followed up for 3 to 26 months, no lesions Residue and relapse. Conclusion Endoscopic submucosal excavation for the treatment of gastrointestinal stromal tumors of less than 30 mm in diameter and luminal growth is a safe, effective and small trauma treatment.