| 张玉珏,李敏.内镜黏膜下挖除术对于消化道固有肌层小于2 cm肿瘤的疗效观察[J].安徽医药,2017,21(4):702-706. |
| 内镜黏膜下挖除术对于消化道固有肌层小于2 cm肿瘤的疗效观察 |
| Efficacy analysis of endoscopic submucosal excavation formuscularispropria tumor withless than 2 cm of diameter |
| 投稿时间：2016-07-14 |
| DOI： |
| 中文关键词: 内镜黏膜下挖除术 治疗 |
| 英文关键词: Endoscopic submucosal excavation Treatment |
| 基金项目: |
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| 摘要点击次数: 2027 |
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| 中文摘要: |
| 目的 探讨内镜黏膜下挖除术(ESE)治疗消化道固有肌层小于2 cm肿瘤安全性及有效性。方法 回顾性分析接受ESE治疗的55例固有肌层小于2 cm肿瘤病人的临床资料。明确ESE治疗固有肌层肿瘤类型、部位、整块切除率、并发症发生率,分析并发症原因及治疗措施,统计平均住院日及住院费用；术后病理、免疫组化及间质瘤危险度分级；病人术前与术后焦虑抑郁评分对比；并通过随访追踪术后情况。结果 55例病变中54例均在胃镜下一次性完整切除,其中1例因术中发现瘤体过大转入外科手术。ESE手术时间42~102 min,平均(70.96±17.84) min。住院日5~30 d,平均(12.95±5.72) d,平均住院费用(13 163.17±7 333.72)元。术中发生穿孔10例,穿孔发生率18.2%(10/55),创面术中予以钛夹或OTSC夹闭创面；术后经胃肠减压、抑酸、抗感染等保守治疗后,无中转开腹手术病例及死亡病例发生；术中均有不同程度渗血,经内镜下热活钳、APC电凝或钛夹夹闭后出血停止。术后迟发性出血1例。术后病理诊断平滑肌瘤25例,血管球瘤1例,血管瘤1例,神经鞘瘤1例,间质瘤27例。间质瘤中极低危险度18例,低危险度7例,中度危险度2例。切缘均为阴性。所有病人术后随访,未发现肿瘤残留及复发。15例病人术前及术后焦虑自评量得分及抑郁自评量表得分均差异有统计学意义(P<0.001)。术前焦虑及抑郁评分均明显高于术后得分。结论 ESE治疗对于小于2 cm固有肌层病变具有创伤小,恢复快,避免病变进一步恶化的特点,并且可以缓解病人焦虑情绪。 |
| 英文摘要: |
| Objective To evaluate the efficacy and safety of submucosal excavation for gastrointestinal submucosal tumors originating from muscularispropria layer whose diameter is less than 2 cm.Methods A total of 55 patients undergoing ESE were analyzed retrospectively.The type of submucosal tumors and its location,en bloc resection rate,complication occurrence rate were evaluated.Causes of complications and therapy were analyzed and the average hospital stay and hospitalization cost were calculated.The whole tumor biopsy was sent to take histological examination and used to determine the risk stratification.The comparison of patients with anxiety before and after ESE was considered during the research.Complication of ESE was recorded and recurrence was investigated during regular follow-up.Results Of 55 cases,the tumors of 54 cases were successfully performed and removed by one procedure.Surgery intervention was applied to 1 case because of severe tumor.The mean procedure time was(70.96±17.84)min(42-102 min).The average length of hospitalization was(12.95±5.72)days (5-30 d).The mean hospitalization cost was(13 163.17±7 333.72) yuan.Perforation occurred in 10 patients(18.2%).All cases were closed with metal clips or OTSC clip.Gastrointestinal decompression,acid suppression with proton pump inhibitors and antibiotics were performed on cases,and none required surgical operation or was dead.Mild bleeding occurred in all cases,which was successfully managed by hot biopsy probe,argon plasma coagulation and mental clip.One case was complicated by postoperative delayed bleeding.Histological results showed 25 leromyomas,1 glomus tumor,1 hemangioma,1 schwannomas,and 27 gastrointestinal stromal tumors.The gastrointestinal stromal tumors were graded as extremely low risk in 18 cases,low risk in 7 cases and moderate risk in 2 cases.There were no pathological involvements in the base or along the incision edge.The patients were followed up for 1to 12 months,and no tumor residue or recurrence was observed.There were significant differencesin score of anxiety scale and score of depression scale in 15 patients(P<0.001),which were higher in preoperation than in postoperation.Conclusions ESE is a safe and reasonable treatment for muscularispropriatumor with less than 2 cm of diameterbecause of the advantages of small wound,rapid recovery,avoidance ofcanceration andstress relief. |
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