CAJ | 학술논문

目的探讨内镜纵切挖除术(ELE)治疗消化道黏膜下肿瘤(SMT)的疗效和可行性.方法对2011年2月至7月经辅助检查和前期治疗明确诊断为起源于消化道的SMT患者19例,在清醒镇静下行ELE治疗:(1)黏膜下注射生理盐水,纵行切开肿瘤表面黏膜和黏膜下层,显露肿瘤.(2)采用内镜黏膜下剥离术沿肿瘤周围分离至肿瘤基底部.(3)胃镜直视下应用Hook刀、IT刀或圈套器完整切除肿瘤.(4)应用金属夹缝合手术创面.结果 19例消化道SMT患者中,病灶位于食道3例、贲门2例、胃底3例、胃体5例、胃窦5例、升结肠1例.ELE成功切除所有病变,完整切除率为100.0％；ELE时间为25～125 min,平均45 min.切除肿瘤直径范围1.5～3.5 cm,平均2.0 cm；病理诊断为平滑肌瘤11例、脂肪瘤5例、间质瘤3例.术后无一例出现出血及腹膜炎体征.住院时间7～15d,平均10d.术后随访1～3个月,平均2个月,无例病变残留.结论 ELE治疗消化道SMT患者是安全有效的,于术方法较内镜黏膜下剥离术简便,便于缩短手术时间及术后并发症的防治,并且有利于术后创面的愈合.
목적 탐토내경종절알제술(ELE)치료소화도점막하종류(SMT)적료효화가행성.방법 대2011년2월지7월경보조검사화전기치료명학진단위기원우소화도적SMT환자19례,재청성진정하행ELE치료:(1)점막하주사생리염수,종행절개종류표면점막화점막하층,현로종류.(2)채용내경점막하박리술연종류주위분리지종류기저부.(3)위경직시하응용Hook도、IT도혹권투기완정절제종류.(4)응용금속협봉합수술창면.결과 19례소화도SMT환자중,병조위우식도3례、분문2례、위저3례、위체5례、위두5례、승결장1례.ELE성공절제소유병변,완정절제솔위100.0％；ELE시간위25～125 min,평균45 min.절제종류직경범위1.5～3.5 cm,평균2.0 cm；병리진단위평활기류11례、지방류5례、간질류3례.술후무일례출현출혈급복막염체정.주원시간7～15d,평균10d.술후수방1～3개월,평균2개월,무례병변잔류.결론 ELE치료소화도SMT환자시안전유효적,우술방법교내경점막하박리술간편,편우축단수술시간급술후병발증적방치,병차유리우술후창면적유합.
Objective To evaluate the feasibility and efficacy of endoscopic longitudinal incision and excavation (ELE) for gastrointestinal submucosal tumors (SMTs). Methods A total of 19 cases of gastrointestinal submucosal tumors (SMTs) was resected by ELE from February 2011 to July 2011 in conscious sedation. ELE consisted of five major procedures, including normal saline injection into the submucosa and longitudinal incision of the mucosal and submucosal along the surface of the lesion, circumferential incision as deep as muscularis propria around the lesion and to its base with endoscopic submucosal dissection (ESD), excavation of the lesion with a Hook knife, IT, or snare and closure of the incision with metallic clips. Results Of 19 gastrointestinal SMTs, 3 located at the esophagus, 2 at the cardia, 3 located at the fundus, 5 at the gastric body, 5 at the antrum, 1 at the ascending colon. ELE was successfully performed in all 19 patients. The complete resection rate was 100％, and the mean operation time was 75 min (25-125 min). The mean tumor size was 2.0cm (1.5-3.5) cm. Pathological examination confirmed Leiomyoma in 3 cascs, lipoma in 5, gastrointestinal stromal tumors (GISTs) in 3 patients. No gastrointestinal bleeding, peritonitis or abdominal abscess occurred after ELE. The mean hospitalization time was 10d (7-15d). The mean follow-up period was 2 months (1-3 months)with no lesion residue. Conclusion ELE was efficacious, safe, and minimally invasive for patients with gastrointestinal SMTs. It can shorten the operation time and the wound cure time after operation, and be easy to prevent operation complication.