CAJ | 학술논문

目的总结9年来诊治小肠间质瘤的经验,探讨双气囊内镜(DBE)在诊治方式变化中的作用.方法回顾性分析193例局灶性小肠间质瘤患者,将其分为小肠CT造影(CTE)和(或)DBE组(n=100)以及其他传统方法组(n=93).然后再分成开腹手术组(n=126)和腹腔镜辅助组(n=67).按照检查和手术方式的发展,比较DBE引进前后的变化.结果 CTE和(或)DBE组患者的平均年龄和肿瘤直径都显著小于传统方法组[年龄(50.9±12.1)与(56.9±11.6)岁,肿瘤直径(3.6±1.3)与(6.1±2.6)cm,P＜0.01].未引进DBE前,2001年1月至2002年12月,均为传统检查方式,开腹手术平均4例/年.引进DBE后,2003年1月至2004年12月,84.6％ (11/13)的患者由DBE检出.2005年1月至2008年12月,50.0％(23/46)的患者由CTE和DBE联合检出.2009年1月至2011年12月,80.5％(33/41)的患者由CTE检出,手术例数已递增至25例/年,较未引进前增加约5.3倍.行腹腔镜辅助切除的患者中,82.1％ (55/67)由CTE和(或)DBE检出,中、低危占89.1％(49/55).结论 DBE对于小肠间质瘤诊治方式的优化具有积极的推动作用.
목적 총결9년래진치소장간질류적경험,탐토쌍기낭내경(DBE)재진치방식변화중적작용.방법 회고성분석193례국조성소장간질류환자,장기분위소장CT조영(CTE)화(혹)DBE조(n=100)이급기타전통방법조(n=93).연후재분성개복수술조(n=126)화복강경보조조(n=67).안조검사화수술방식적발전,비교DBE인진전후적변화.결과 CTE화(혹)DBE조환자적평균년령화종류직경도현저소우전통방법조[년령(50.9±12.1)여(56.9±11.6)세,종류직경(3.6±1.3)여(6.1±2.6)cm,P＜0.01].미인진DBE전,2001년1월지2002년12월,균위전통검사방식,개복수술평균4례/년.인진DBE후,2003년1월지2004년12월,84.6％ (11/13)적환자유DBE검출.2005년1월지2008년12월,50.0％(23/46)적환자유CTE화DBE연합검출.2009년1월지2011년12월,80.5％(33/41)적환자유CTE검출,수술례수이체증지25례/년,교미인진전증가약5.3배.행복강경보조절제적환자중,82.1％ (55/67)유CTE화(혹)DBE검출,중、저위점89.1％(49/55).결론 DBE대우소장간질류진치방식적우화구유적겁적추동작용.
Objective To investigate the role of double-balloon enteroscopy (DBE) in the evolution of detection and surgical treatment of small bowel stromal tumors (SBSTs),based on nine years experience.Methods In this retrospective study,193 patients with localized SBSTs were divided into the CT-enterography (CTE) and/or DBE group (n =100) and conventional modalities group (n =93).These patients were further divided into the open surgery group (n =126) and laparoscopy-assisted resection group (n =67).The development of clinical diagnosis and surgical treatment strategies were compared before and after the introduction of DBE.Results The average age and tumor size were significantly smaller in the CTE and/or DBE group than those in the conventional modalities group,respectively (age:50.9 ± 12.1 vs.56.9 ± 11.6 years; tumor size:3.6 ± 1.3 vs.6.1 ± 2.6 cm,P ＜ 0.01).Before the introduction of DBE (from January 2001 to December 2002),all patients underwent conventional modalities,and only 4 cases/year for open surgery.Afterward,from January 2003 to December 2004,84.6％ (11/13) of SBSTs were detected by DBE.From January 2005 to December 2008,50.0％ (23/46) of SBSTs were found by CTE combination with DBE.From January 2009 to December 2011,80.5％ (33/41) of SBSTs were diagnosed by CTE,and the number of patients underwent operation increased up to 25 cases/year,which was nearly 5.3 folds higher than that before the introduction of DBE.Sixty-seven patients were successfully operated by laparoscopy-assisted resection,82.1％ (55/67) of them were detected by CTE ands/or DBE,89.1％ (49/55) of whom had low-or intermediate-risk SBSTs.Conclusion DBE plays an important role in optimizing the algorithm of detection and treatment of SBSTs.