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目的采用内镜下微创手术切除食管和胃粘膜下肿瘤,观察疗效及安全性。方法内镜诊断食管粘膜下肿瘤25例和胃粘膜下肿瘤8例,直径0·8~5·5cm。分别直接套切10例,粘膜切除15例,针状刀剥离切除5例,2例仅予以热活检,另1例转外科手术。切除标本行常规病理及免疫组化检查,术后定期内镜随访。结果33例中30例(93·9%)内镜治疗均获得完全切除。术后3例发生创面出血,经钛夹成功止血,6例有轻度胸骨后疼痛,未发生其他并发症。病理报告食管平滑肌瘤18例,食管间质肿瘤7例,胃间质肿瘤8例。所有病例术后4周复查胃镜,并随访1~28个月不等,未见复发或远期并发症。结论内镜微创手术切除小于2cm的食管或胃粘膜下肿瘤安全有效。
Objective To observe the efficacy and safety of endoscopic esophagectomy and gastric mucosal resection with minimally invasive surgery. Methods 25 cases of esophageal submucosal tumors and 8 cases of gastric submucosal tumors were diagnosed by endoscopy. The diameters of the tumors were 0.8-8.5 cm. 10 cases were directly sheathed, mucosal resection in 15 cases, needle-knife resection in 5 cases, 2 cases were only biopsy, and the other 1 case transferred to surgery. The specimens were removed for routine pathology and immunohistochemistry, followed by regular endoscopic follow-up. Results In 33 cases, 30 cases (93.9%) were completely resected by endoscopic treatment. There were 3 wounds hemorrhage occurred after operation, hemostasis was successfully achieved by titanium clips, 6 patients had slight post-sternal pain and no other complications occurred. Pathological report of 18 cases of esophageal leiomyoma, esophageal stromal tumors in 7 cases, 8 cases of gastric stromal tumors. Gastric endoscopy was performed in all cases 4 weeks after operation and was followed up for 1 ~ 28 months. No recurrence or long-term complications were found. Conclusion Endoscopic minimally invasive surgical resection less than 2cm of esophageal or gastric submucosal tumors safe and effective.