CAJ | 학술논문

目的探讨改良的内镜下结扎剥离术(ESD-L)对胃固有肌层小肿瘤的治疗价值.方法对经超声胃镜检查证实来源于胃固有肌层、直径≤12 mm的黏膜下肿瘤(SMT) 60例,先行应用常规ESD术剥离至固有肌层深部后,继而对瘤体及其底部固有肌层充分结扎,结扎后继续剥离直至完整剥离瘤体.随访观察治疗效果.结果 60例病变全部完整切除,10例出现穿孔,行全层切除后金属止血夹封闭创面,未转外科手术,无其他并发症发生.60例均获得病理诊断,随访期内未见复发病例.结论应用剥离后结扎再剥离的改良ESD-L术治疗来源于固有肌层的SMT既能达到完全剥离,减少病灶残留的治疗目的,又能降低因实施全层切除而导致胃壁穿孔的风险.
목적 탐토개량적내경하결찰박리술(ESD-L)대위고유기층소종류적치료개치.방법 대경초성위경검사증실래원우위고유기층、직경≤12 mm적점막하종류(SMT) 60례,선행응용상규ESD술박리지고유기층심부후,계이대류체급기저부고유기층충분결찰,결찰후계속박리직지완정박리류체.수방관찰치료효과.결과 60례병변전부완정절제,10례출현천공,행전층절제후금속지혈협봉폐창면,미전외과수술,무기타병발증발생.60례균획득병리진단,수방기내미견복발병례.결론 응용박리후결찰재박리적개량ESD-L술치료래원우고유기층적SMT기능체도완전박리,감소병조잔류적치료목적,우능강저인실시전층절제이도치위벽천공적풍험.
Objective To explore the therapeutic value of modified endoscopic submucosal dissection with ligation (ESD-L) for small tumors originated from gastric muscularis propria.Methods Total of 60 patients with tumors originated from gastric muscularis propria,which was confirmed by endoscopic ultrasonography and smaller than 12 mm and were recruited to the present study.The conventional ESD technique was used to dissect the tumor to the depth of muscularis propria.Then the bottom of the tumor and the beneath muscularis propria were ligated fully with a nylon loop.Further dissection was applied till the whole tumor was isolated.Results All 60 lesions were dissected completely with perforation occurred in 10 cases,which were managed successfully with metal hemoclip.Pathologic diagnosis was obtained in all lesions,and no recurrence was found during the follow-up.Conclusion Modified technique of ESD-L is effective for complete resection of small tumors originated from gastric muscularis propria,which can also decrease the risk of stomach perforation.