EFR治疗胃固有肌层肿物25例

目的探讨内镜全层切除术(EFR)治疗源于固有肌层的胃黏膜下肿物(SMT)的疗效和安全性。方法 25例于2011年1月至2013年9月于我院接受EFR治疗的胃SMT患者纳入研究,肿瘤经EUS和增强CT检查诊断为来源于固有肌层。对其治疗结果、并发症发生情况、近期随访结果等进行回顾性分析。结果 25例均完整切除病灶,病灶长径1.0~5.5 cm,黏膜切开至黏膜切口完整缝合时间为60~180 min,使用止血夹5~30枚,住院天数3~9 d,医疗费用8 000~20 000元。术后病理诊断间质瘤22例,平滑肌瘤2例,神经鞘瘤1例,切缘均为阴性。术后无出血,1例出现腹膜炎。出院后3个月内镜复查未见病变残留、复发。结论 EFR治疗来源于固有肌层的胃SMT安全、有效,可成为胃SMT的治疗选择。

Endoscopic full-thickness resection for gastric submucosal tumors originated from muscularis propria layer

Objective To evaluate the efficacy and safety of endoscopic full-thickness resection （EFR） for gastric submucosal tumors （SMTs） originating from the muscularis propria （MP） layer. Methods Twenty five cases of gastric SMT treated by EFR at our hospital from Jan.2011 to Sep. 2013 were enrolled.SMTs were diagnosed as originating from muscularis propria by EUS and contrast-enhanced CT. The treatment outcome, complications and short term follow-up were retrospectively analyzed. Results All 25 lesions were resected en bloc by EFR. The lesion size ranged from 1.0~5.5 cm, and the time of procedure was 60~180 minutes, using 5~30 hemostatic clamp. Hospital stay was 3~9 days. Medical expenses ranged from 8,000~20,000 yuan. Pathologically, 22 SMTs were diagnosed as stromal tumors, 2 as leiomyoma, and 1 as neurilemmoma. Both lateral and vertical resection margins were tumor free in all cases. No post-procedure bleeding was noted. Peritonitis occurred in one patient. No residual or recurrent lesions were found in endoscopic follow-up 3 months after discharge. Conclusions EFR is a safe and effective approach, and it might be a promising alterna-tive for the treatment of gastric SMTs originating from muscularis propria.