内镜下胃壁全层切除术对胃间质瘤的治疗价值研究

目的初步探讨内镜下胃壁全层切除术（EFTR）对胃间质瘤治疗的价值。方法2010年1月至2011年7月对33例病灶大、位于固有肌深层胃间质瘤行内镜下胃壁全层切除术治疗，观察疗效及安全性，并与同期行内镜黏膜下切除术（ESD）治疗的34例胃间质瘤病例在有效性、安全性、手术复杂程度等方面进行比较。结果33例EFTR治疗的病例中，2例因病灶过大未能完成手术，其余均顺利切除病灶，术后恢复良好，随访12个月无复发。与ESD治疗病例相比，手术切除率（93．9％比100％）、并发症发生率（6．5％比2．9％）、术后3d平均体温（37．2±0．4）℃比（37．0±0．4）℃]及血常规白细胞总数（8．5±8．0）×10^9／L比（6．1±1．7）×10^9／L]、术后恢复时间（6．1±2．1）d比（5．2±2．8）d]，差异均无统计学意义。EFTR组术中钛夹使用个数（7．0±3．5）比（4．9±3．1），t=2．55，P〈0．05]及术后禁食天数（3．4±1．5）d比（2．0±1．0）d，t=4．36，P〈0．05]明显多于ESD组。结论EFTR对胃问质瘤的治疗是安全、有效的，与ESD术式比较EFTR手术风险并未明显增加，但作为ESD手术的扩展，EYrR手术更为复杂。

Endoscopic full-thickness resection for gastric stromal tumor

Objective To evaluate the therapeutic effect of endoscopic full-thickness resection (EFTR) for gastric stromal tumors.Methods A total of 33 patients with gastric stromal tumor orgination from deep muscularis propria layer received EFTR from January 2010 to July 2011.The effectiveness and safety of EFTR were compared with those of other 34 patients with gastric stromal tumor origination from muscularis propria layer who underwent endoscopic submucosal dissection (ESD).Results Except in 2 patients with lesions larger than 3.0 × 3.0 cm,EFTR was successful in others 31 patients,who recovered well and had no recurrence during the follow-up within 12 months.There were no significant differences in resection rate,incidence of complications,body temperature,white blood cell counts or recovery time between 2 procedures (P ＞ 0.05 ).However,the number of clips used in EFTR ( 7.0 ± 3.5 vs.4.9 ± 3.1,P =0.013 ) and postoperative fasting days (3.4 ± 1.5 vs.2.0 ± 1.0,P =0.001 ) were significantly higher than those of ESD procedures.Conclusion EFTR is effective and safe for gastric stromal tumors with no higher risk than ESD,but it is more complex technically.EFTR can be used as an expanding method of ESD in endoscopic treatment of gastric stromal tumors.