CAJ | 학술논문

目的：探讨内镜下微创治疗胃间质性肿瘤的疗效和安全性。方法选择我院消化内科2009年4月至2013年3月经超声内镜检查来源于胃固有肌层的GIST的患者，符合入组标准患者24例，其中男14例，女10例；年龄33~67岁，年龄平均52岁。病变位于胃角4例，胃底8例，胃窦8例，胃小弯2例，直径5~22 mm，平均10.9 mm。首先对胃黏膜下病变采用脱气水法行EUS检查，明确病变为起源于胃固有肌层后。采用结扎、切开、剥离、创面处理、病理检测等处理，观察治疗效果及评价其安全性。结果24例肿瘤均位于胃固有肌层，22例在内镜下完整切除，2例无法完全切除。术后病理组织学及免疫组织化学检查确诊胃间质性肿瘤16例，均为极低及低度恶性间质瘤；胃平滑肌瘤4例，胃神经纤维瘤2例，胃血管球瘤2例。术后无继发胃穿孔、胃出血等严重并发症，术后随访24例，创面均愈合，无复发病例。结论胃镜微创治疗小的胃间质性肿瘤安全、有效，预后良好。
목적：탐토내경하미창치료위간질성종류적료효화안전성。방법선택아원소화내과2009년4월지2013년3월경초성내경검사래원우위고유기층적GIST적환자，부합입조표준환자24례，기중남14례，녀10례；년령33~67세，년령평균52세。병변위우위각4례，위저8례，위두8례，위소만2례，직경5~22 mm，평균10.9 mm。수선대위점막하병변채용탈기수법행EUS검사，명학병변위기원우위고유기층후。채용결찰、절개、박리、창면처리、병리검측등처리，관찰치료효과급평개기안전성。결과24례종류균위우위고유기층，22례재내경하완정절제，2례무법완전절제。술후병리조직학급면역조직화학검사학진위간질성종류16례，균위겁저급저도악성간질류；위평활기류4례，위신경섬유류2례，위혈관구류2례。술후무계발위천공、위출혈등엄중병발증，술후수방24례，창면균유합，무복발병례。결론위경미창치료소적위간질성종류안전、유효，예후량호。
Objective To explore the curative effect and safety of endoscopic minimally invasive treatment for gastrointestinal stromal tumors. Methods 24 patients with SMT were selected in our depatment gastroenterology from April 2009 to March 2013 who were confimed with SMT from stomach muscularis propria through EUS, including 14 male cases, 10 female cases. The patients were aged from 33 to 67, with the average age of 52. Lesions located in the stomach angle (4 cases), fundus of stomach (8 cases), gastric antrum (8 cases), curvatura veutriculi minor (2 cases), with a diameter of 5 ~ 22 mm, the average of 10.9 mm. Firstly, EUS by de-aerated water was implemented to the gastric submucosal lesions to confirm that the lesions stem from stomach muscularis propria . Then the leisions were treated with ligation, cutting, stripping, wound treatment and pathological detection. The primary outcome was an evaluation of the clinical efficacy and safety of the treatment. Results 24 cases of tumors were located in the muscularis propria, with 22 cases which were treated with complete endoscopic excision and 2 cases which cannot be completely removed. Postoperative pathological histology and immunohistochemical examination confirmed 16 cases of gastric stromal tumor which was extremely low or low-grade malignant stromal tumors, 4 cases of gastric leiomyoma, 2 case s of neurofibroma, 2 case s of gastric glomus tumor. No postoperative secondary gastric perforation, severe stomach bleeding and other complications occured. In the postoperative follow-up of 24 cases, wounds were healed, with no recurrence. Conclusions Endoscopic minimally invasive treatment for small gastric stromal tumor is safe, effective, with good prognosis.