CAJ | 학술논문

目的评价内镜经黏膜下隧道肿瘤切除术(STER)治疗来源于固有肌层的胃黏膜下肿瘤(SMT)的临床应用价值.方法回顾性分析2010年9月至2011年12月间在复旦大学附属中山医院内镜中心接受STER术的23例来源于固有肌层的胃SMT患者的临床病理资料.结果男性13例,女性10例,年龄28～73(平均52.4)岁.23例胃SMT中贲门近胃体侧11例,贲门近胃底侧4例,胃体小弯5例,胃窦大弯侧3例.来源于固有肌层浅层14例,深层9例,其中5例与浆膜层粘连,密不可分.23例STER手术均获成功,所有SMT均完整切除,切除病变直径1.5～3.2(平均2.1)cm；肿瘤切除至黏膜切口完整缝合时间30～125(平均54.8)min.术后病理诊断:平滑肌瘤10例,胃肠间质瘤8例,血管球瘤2例,神经鞘膜瘤2例,钙化性纤维性肿瘤1例；切缘均为阴性.发生气胸伴皮下气肿3例次,气腹5例次,左侧膈下积液伴继发感染1例次,均予保守治疗痊愈.术后无迟发性消化道出血、消化道瘘、黏膜下隧道内积血积液和感染病例.随访3～18个月,无一例病变残留或复发.结论 STER治疗适宜部位的胃固有肌层SMT安全、有效,能够一次性完整切除病变,提供完整的病理学诊断资料,且可以迅速恢复消化道完整性,避免消化道瘘的发生.
목적 평개내경경점막하수도종류절제술(STER)치료래원우고유기층적위점막하종류(SMT)적림상응용개치.방법 회고성분석2010년9월지2011년12월간재복단대학부속중산의원내경중심접수STER술적23례래원우고유기층적위SMT환자적림상병리자료.결과 남성13례,녀성10례,년령28～73(평균52.4)세.23례위SMT중분문근위체측11례,분문근위저측4례,위체소만5례,위두대만측3례.래원우고유기층천층14례,심층9례,기중5례여장막층점련,밀불가분.23례STER수술균획성공,소유SMT균완정절제,절제병변직경1.5～3.2(평균2.1)cm；종류절제지점막절구완정봉합시간30～125(평균54.8)min.술후병리진단:평활기류10례,위장간질류8례,혈관구류2례,신경초막류2례,개화성섬유성종류1례；절연균위음성.발생기흉반피하기종3례차,기복5례차,좌측격하적액반계발감염1례차,균여보수치료전유.술후무지발성소화도출혈、소화도루、점막하수도내적혈적액화감염병례.수방3～18개월,무일례병변잔류혹복발.결론 STER치료괄의부위적위고유기층SMT안전、유효,능구일차성완정절제병변,제공완정적병이학진단자료,차가이신속회복소화도완정성,피면소화도루적발생.
Objective To evaluate the clinical value of submucoal tunneling endoscopic resection (STER) for gastric submucosal tumor (SMT) originating from the muscularis propria (MP) layer.Methods Clinicopathological data of 23 cases with gastric SMT originating from the MP layer treated with STER from September 2010 to December 2011 were analyzed retrospectively.Results There were 13 males and 10 females.The age ranged from 28 to 73 (mean,52.4) years old.Of the 23 SMTs,11 were located in the cardia adjacent to the gastric body,4 in the cardia adjacent to the fundus,5 in the lesser curvature of gastric body and 3 in the gastric antrum of greater curvature.All the SMTs originating from the MP layer,14 were located in the superficial MP layer and 9 in the deep MP layer(including 5 gastric SMTs close to serosa).En bloc STER was performed successfully in all the patients.The mean lesion size was 2.1 cm (range 1.5-3.2 cm).The mean procedure time was 54.8 min (range 30-125 min).Pathological examination showed that the lesions were leiomyomas(n=10),stromal tumors (n=8),glomus tumor (n=2),Sehwannoma (n=2),and calcifying fibrous tumor (n=1).Both lateral and vertical margins were negative in all the cases.Three patients developed pneumothorax and subcutaneous emphysema and 5 pneumoperitoneum.One patient developed effusion under the left half of the diaphragm and secondary infection.All of them recovered uneventfully after conservative treatments.No delayed bleeding or GI tract leakage was noticed.None of the 23 cases encountered submucosal hematoma or infection.No tumor residual or recurrence was found during the follow up (range,3-18months).Conclusions STER is a safe,effective for appropriate lesions in the MP layer of the stomach.En bloc resection and accurate histopathological evaluations can be achieved.