超声内镜指导内镜黏膜下剥离术治疗来源于固有肌层胃黏膜下肿瘤的疗效和安全性研究
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摘要
目的探讨超声内镜指导内镜黏膜下剥离术治疗来源于固有肌层胃黏膜下肿瘤的疗效和安全性。方法回顾性选取2015年5月至2017年5月收治的来源于固有肌层胃黏膜下肿瘤患者60例,依据治疗方法将这些患者分为超声内镜指导内镜黏膜下剥离术组(内镜微创组,n=30)和传统开腹手术治疗组(传统开腹组,n=30)两组。对两组患者的术中术后指标、Flether分级情况、术后并发症发生情况、肿瘤完全切除情况及术后复发情况进行统计分析。结果和传统开腹组相比,内镜微创组患者的手术时间、术后首次肛门排气时间、住院时间均显著较短,术中出血量显著较少(P <0. 05);内镜微创组患者的术后并发症发生率10. 0%(3/30)显著低于传统开腹组23. 3%(7/30)(P <0. 05),肿瘤完全切除率96. 7%(29/30)显著高于传统开腹组76. 7%(23/30)(P <0. 05),复发率6. 7%(2/30)显著低于传统开腹组23. 3%(7/30)(P <0. 05),但两组患者的Flether分级高风险、中风险、低风险、极低风险比率比较,差异均无显著性(P> 0. 05)。结论超声内镜指导内镜黏膜下剥离术治疗来源于固有肌层胃黏膜下肿瘤的疗效较传统开腹手术显著,安全性较高。
Objective To investigate the efficacy and safety of endoscopic submucosal dissection guided by endoscopic ultrasonography in the treatment of submucosal tumors of the intrinsic myometrium of the gastric mucosa. Methods 60 cases of patients with submucosal tumors of the intrinsic myometrium of the gastric mucosa from May 2015 to May 2017 in our hospital were randomly selected,these patients were divided into endoscopic ultrasound guided endoscopic submucosal dissection group( endoscopic group,n = 30) and traditional open surgery treatment group( conventional laparotomy group,n = 30) according to the treatment methods. The intraoperative and postoperative indexes,Flether grades,postoperative complications and recurrences of tumor complete resection and postoperative recrudescencess of the two groups were statistically analyzed.Results Compared with the conventional laparotomy group,the operation time,postoperative first anal exhaust time,hospitalization time of the endoscopic group were significantly shorter( P < 0. 05),and the amount of bleeding was significantly less( P < 0. 05). The postoperative complication rate of the endoscopic group 10. 0%( 3/30) was significantly lower than the conventional laparotomy group 23. 3%( 7/30)( P< 0. 05),the complete tumor resection rate 96. 7%( 29/30) was significantly higher than the conventional laparotomy group 76. 7%( 23/30)( P < 0. 05). The recurrence rate 6. 7%( 2/30) was significantly lower than the conventional laparotomy group 23. 3%( 7/30)( P < 0. 05).The differences of Flether classification of high risk,medium risk,low risk and very low risk rates between the two groups were not significant( P> 0. 05). Conclusion The efficacy and safety of endoscopic submucosal dissection guided by endoscopic ultrasonography in the treatment of submucosal tumors of the intrinsic myometrium of the gastric mucosa is more significant than traditional open surgery,and the safety is higher.
Objective To investigate the efficacy and safety of endoscopic submucosal dissection guided by endoscopic ultrasonography in the treatment of submucosal tumors of the intrinsic myometrium of the gastric mucosa. Methods 60 cases of patients with submucosal tumors of the intrinsic myometrium of the gastric mucosa from May 2015 to May 2017 in our hospital were randomly selected,these patients were divided into endoscopic ultrasound guided endoscopic submucosal dissection group( endoscopic group,n = 30) and traditional open surgery treatment group( conventional laparotomy group,n = 30) according to the treatment methods. The intraoperative and postoperative indexes,Flether grades,postoperative complications and recurrences of tumor complete resection and postoperative recrudescencess of the two groups were statistically analyzed.Results Compared with the conventional laparotomy group,the operation time,postoperative first anal exhaust time,hospitalization time of the endoscopic group were significantly shorter( P < 0. 05),and the amount of bleeding was significantly less( P < 0. 05). The postoperative complication rate of the endoscopic group 10. 0%( 3/30) was significantly lower than the conventional laparotomy group 23. 3%( 7/30)( P< 0. 05),the complete tumor resection rate 96. 7%( 29/30) was significantly higher than the conventional laparotomy group 76. 7%( 23/30)( P < 0. 05). The recurrence rate 6. 7%( 2/30) was significantly lower than the conventional laparotomy group 23. 3%( 7/30)( P < 0. 05).The differences of Flether classification of high risk,medium risk,low risk and very low risk rates between the two groups were not significant( P> 0. 05). Conclusion The efficacy and safety of endoscopic submucosal dissection guided by endoscopic ultrasonography in the treatment of submucosal tumors of the intrinsic myometrium of the gastric mucosa is more significant than traditional open surgery,and the safety is higher.
引文
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[3]李军,施毅卿,姜松耀.内镜辅助胃癌黏膜下剥离术治疗胃癌前病变及早期胃癌效果分析[J].临床和实验医学杂志,2018,17(6):637-640.
[4]杨莉,李胜昔,徐美东,等.内镜黏膜下剥离术及全层切除术治疗胃黏膜下肿瘤的临床疗效分析[J].中国内镜杂志,2015,21(1):37-41.
[5]王军,樊丽琳,沈小春,等.小探头超声内镜联合CT检查对较大胃黏膜下肿瘤治疗方案选择的价值[J].第三军医大学学报,2012,34(12):1135-1137.
[6]余福兵,何夕昆,诸琦,等.超声内镜在胃间质瘤不同侵袭危险性分级中的价值探讨[J].中华消化内镜杂志,2010,27(1):32-34.
[7]孙圣斌,黄曼玲,刘爱斯,等.内镜黏膜下剥离术治疗上消化道固有肌层肿瘤的探讨[J].中国内镜杂志,2014,20(3):277-281.
[8] Watson RR,Binmoeller KF,Hamerski CM,et al. Yield and performance characteristics of endoscopic ultrasound-guided fine needle aspiration for diagnosing upper GI tract stromal tumors[J]. Dig Dis Sci,2011,56(6):1757-1762.
[9] Jiang G,Zhao H,Yang F,et al. Thoracoscopic enucleation of esophageal leiomyoma:a retrospective study on 40 cases[J]. Dis Esophagus,2009,22(3):279-283.
[10] Ray S,Saluja SS,Gupta R,et al. Esophageal leiomyomatosis-an unusual cause of pseudoachalasia[J]. Can J Gastroenterol,2008,22(2):187-189.
[11] Huang HL,Leung CY,Cheng CJ. Mass-like Dieulafoy's lesion associated with advanced gastric cancer at the antrum of stomach:a case report and literature review[J]. Diagn Pathol,2017,12(1):73.
[12] Ebi M,Sugiyama T,Yamamoto K,et al. A gastric glomus tumor resected using non-exposed endoscopic wall-inversion surgery[J]. Clin J Gastroenterol,2017,10(6):508-513.
[13] Mahawongkajit P,Techagumpuch A,Suthiwartnarueput W. Non-exposed endoscopic wall-inversion surgery for a gastrointestinal stromal tumor of the stomach:A case report[J]. Oncol Lett,2017,14(4):4746-4750.
[14] Manabe S,Mukaisho KI,Yasuoka T,et al. Gastric adenocarcinoma of fundic gland type spreading to heterotopic gastric glands[J]. World J Gastroenterol,2017,23(38):7047-7053.
[15] Scherübl H,Cadiot G. Early Gastroenteropancreatic Neuroendocrine Tumors:Endoscopic Therapy and Surveillance[J]. Visc Med,2017,33(5):332-338.
[2] CSCO胃肠间质瘤专家委员会.中国胃肠间质瘤诊断治疗专家共识(2011年版)[J].临床肿瘤学杂志,2011,16(9):836-844.
[3]李军,施毅卿,姜松耀.内镜辅助胃癌黏膜下剥离术治疗胃癌前病变及早期胃癌效果分析[J].临床和实验医学杂志,2018,17(6):637-640.
[4]杨莉,李胜昔,徐美东,等.内镜黏膜下剥离术及全层切除术治疗胃黏膜下肿瘤的临床疗效分析[J].中国内镜杂志,2015,21(1):37-41.
[5]王军,樊丽琳,沈小春,等.小探头超声内镜联合CT检查对较大胃黏膜下肿瘤治疗方案选择的价值[J].第三军医大学学报,2012,34(12):1135-1137.
[6]余福兵,何夕昆,诸琦,等.超声内镜在胃间质瘤不同侵袭危险性分级中的价值探讨[J].中华消化内镜杂志,2010,27(1):32-34.
[7]孙圣斌,黄曼玲,刘爱斯,等.内镜黏膜下剥离术治疗上消化道固有肌层肿瘤的探讨[J].中国内镜杂志,2014,20(3):277-281.
[8] Watson RR,Binmoeller KF,Hamerski CM,et al. Yield and performance characteristics of endoscopic ultrasound-guided fine needle aspiration for diagnosing upper GI tract stromal tumors[J]. Dig Dis Sci,2011,56(6):1757-1762.
[9] Jiang G,Zhao H,Yang F,et al. Thoracoscopic enucleation of esophageal leiomyoma:a retrospective study on 40 cases[J]. Dis Esophagus,2009,22(3):279-283.
[10] Ray S,Saluja SS,Gupta R,et al. Esophageal leiomyomatosis-an unusual cause of pseudoachalasia[J]. Can J Gastroenterol,2008,22(2):187-189.
[11] Huang HL,Leung CY,Cheng CJ. Mass-like Dieulafoy's lesion associated with advanced gastric cancer at the antrum of stomach:a case report and literature review[J]. Diagn Pathol,2017,12(1):73.
[12] Ebi M,Sugiyama T,Yamamoto K,et al. A gastric glomus tumor resected using non-exposed endoscopic wall-inversion surgery[J]. Clin J Gastroenterol,2017,10(6):508-513.
[13] Mahawongkajit P,Techagumpuch A,Suthiwartnarueput W. Non-exposed endoscopic wall-inversion surgery for a gastrointestinal stromal tumor of the stomach:A case report[J]. Oncol Lett,2017,14(4):4746-4750.
[14] Manabe S,Mukaisho KI,Yasuoka T,et al. Gastric adenocarcinoma of fundic gland type spreading to heterotopic gastric glands[J]. World J Gastroenterol,2017,23(38):7047-7053.
[15] Scherübl H,Cadiot G. Early Gastroenteropancreatic Neuroendocrine Tumors:Endoscopic Therapy and Surveillance[J]. Visc Med,2017,33(5):332-338.
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