引用本文:李 姣,陈伟庆.应用内镜下圈套器法黏膜切除术治疗上消化道间质瘤[J].重庆医科大学学报,2012,37(1):79~83
应用内镜下圈套器法黏膜切除术治疗上消化道间质瘤
Endoscopic mucosal resection with a ligator device for the treatment of upper gastrointestinal stromal tumors
DOI:
中文关键词:  胃肠道间质瘤  内镜下黏膜切除术  圈套器  内镜下微创治疗
英文关键词:gastrointestinal stromal tumors  endoscopic mucosal resection  ligator device  minimally invasive endoscopy
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作者单位
李 姣,陈伟庆 重庆医科大学第二附属医院消化内科重庆 400010 
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中文摘要:
      目的:评价内镜下圈套器法黏膜切除术(Endoscopic mucosal resection with ligator device,EMR-L)对上消化道间质瘤治疗的临床有效性、安全性,技术的可行性。方法:回顾性分析我院消化内科从2007年5月到2011年5月行EMR-L治疗的上消化道间质瘤患者共53例。EMR-L包括吸引-圈套-切除-封闭4步,在常规的EMR-L基础上有两点改进:一是结扎2个橡胶圈,二是在圈套后形成的假蒂基部两端黏膜面各固定肽夹1枚。观察患者临床特点、内镜表现、EMR-L术及其并发症和病理检查结果,术后定期胃镜随访。结果:共有53例患者纳入本次研究,平均年龄为51.7岁(22~76)岁,男女比例为1∶2.3(16∶37),肿瘤平均大小为0.95 cm(0.3~2.5) cm,EMR-L成功切除51例(成功率为96.2%),2例失败转外科手术治疗,手术平均时间为25 min(14~56) min。EMR-L相关并发症包括胃穿孔4例(7.5%),胸骨后不适5例(9.4%)、上腹不适5例(9.4%)。术后病检均证实为间质瘤,其中食管间质瘤23例,胃间质瘤30例。随访3~43月(平均13.5月)1例复发,复发率为1.9%。结论:EMR-L对于≤2.5 cm局限性上消化道间质瘤是一种简单、快速、安全、有效和可行性的治疗措施。
英文摘要:
      Objective:To evaluate the clinical efficacy,safety,and technical feasibility of endoscopic mucosal resection with ligator device(EMR-L) for gastrointestinal stromal tumors(GISTs) of upper gastrointestinal tract. Methods:This is a retrospective medical record review,which includes fifty-three consecutive patients,who underwent EMR-L for GISTs in upper GI tract from May,2007,to May,2011. Our EMR-L includes four steps as suction,ligation,snare and closure,which has two improvements compared with conven-tional EMR-L. One is ligating two elastic bands,and the other is fixing two clips before snare. The outcome measures included:base-line patient characteristics,endoscopic outcomes,procedural complications,pathological outcomes,and follow-up outcomes. Results:A total of 53 patients were eligible for inclusions in the study,the mean age being 51.7(range 22~76)years,the male/female ratio be-ing 1∶2.3(16∶37). The tumors were all protruding lesions with hemisphere or strip shape,and the mean lesion size under EUS was 0.95(range 0.3~2.5) cm. EMR-L was easily and successfully performed in 51 patients(success rate,96.2%),but failed in 2 patients who turned to surgery treatment. The mean procedure time was 25(range,14~56) minutes.Serious complications included gastric per-foration 7.5%(4 of 53);mild complications included retrosternal discomfort 9.4%(5 of 53) and abdominal discomfort 9.4%(5 of 53). The postoperative histological diagnosis was GISTs for all cases,37.7%(23 of 53) in esophagus and 62.3%(30 of 53) in stomach. Dur-ing a mean follow-up period of 13.5 months(range,3~43 months),there was only one recurrence observed 12 months postoperatively with the recurrence rate of 1.9%. Conclusion:EMR-L is an effective,safe and feasible endoscopic modality for the treatment of small (≤2.5 cm) upper GISTs.
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