内镜粘膜下挖除术对于消化道固有肌层小于2cm肿瘤的疗效分析

发布时间：2018-05-03 15:55

本文选题：固有肌层肿瘤 + 内镜粘膜下挖除术　；参考：《安徽医科大学》2017年硕士论文

【摘要】：研究背景与目的消化道固有肌层肿瘤常常在胃镜检查中偶然发现,大部分病变为良性,但是也有一部分病变是恶性或者是潜在恶性,对此类病变尤其是病理为间质瘤的治疗主要包括手术治疗,药物治疗,以及通过内镜定期观察病变变化,然而对于内镜治疗并无明确指证,尤其缺乏对于临床常见的小于2cm病变治疗可行性的研究资料。本研究通过分析内镜治疗固有肌层小于2cm肿瘤的临床资料,探讨内镜黏膜下挖除术(endoscopic submucosal excavation,ESE)治疗消化道固有肌层小于2cm肿瘤安全性及有效性,制定本地区治疗诊疗规范。方法回顾性分析2013年-2016年在我院接受ESE治疗的55例固有肌层小于2cm肿瘤患者的临床资料。手术操作过程中中观察并发症发生及处理方案,切除标本常规行病理组织学检查及免疫组化检查,术后进行内镜随访。明确我院ESE治疗固有肌层肿瘤类型,肿瘤所在部位、整块切除率、并发症发生率,分析并发症原因及治疗措施,统计平均住院日及住院费用;术后分析病理、免疫组化结果,对病理为间质瘤的病变进行危险度分级;通过焦虑抑郁量表对部分患者术前与术后焦虑抑郁进行评分,分析整理所有临床数据;术后通过胃镜或超声胃镜检查进行随访,观察病变区域愈合,局部残留及复发情况,从而得出结论。结果55例病变其中54例病变均在胃镜下完整切除,其中1例因术中发现瘤体过大转入外科手术。ESE手术时间为42-102min,平均时间70.96±17.84min。平均住院日12.95±5.72d,平均住院费用13163.17±7333.72元。术中发生穿孔10例,穿孔发生率18.2%(10/55),创面术中予以钛夹或OTSC夹闭创面;术后经胃肠减压、抑酸、补液等保守治疗后,无病例转入外科手术治疗且无死亡病例;术中均有不同程度渗血,经内镜下止血如肾上腺素喷洒、内镜下热活钳、APC电凝或钛夹夹闭后等出血停止。术后迟发性出血1例。术后病理诊断提示血管球瘤1例,平滑肌瘤25例;血管瘤1例;神经鞘瘤1例;间质瘤27例。其中病理及免疫组化提示间质瘤的病变,根据胃肠间质瘤分级标准(2008)危险度分级:极低危险度18例,低危险度7例,中度危险度2例。切缘均为阴性。所有患者术后通过胃镜复查随访,原手术区域愈合可,未发现肿瘤残留及复发。15例患者术前及术后焦虑自评量得分及抑郁自评量表得分差异均具有统计学意义(P0.001)。术前焦虑及抑郁评分均明显高于术后得分。结论ESE治疗对于小于2cm固有肌层病变具有创伤小,恢复快,避免病变进一步恶化的特点,并且可以缓解患者焦虑情绪。
[Abstract]:Background and objective Gastrointestinal muscularis propria tumors are often found by chance in gastroscopy. Most lesions are benign, but others are malignant or potentially malignant. The treatment of such lesions, especially pathological stromal tumors, includes surgical treatment, drug therapy, and regular observation of lesions through endoscopy, but there is no clear indication of endoscopic therapy. In particular, there is a lack of research data on the clinical feasibility of treatment of lesions less than 2cm. In this study, we analyzed the clinical data of endoscopic treatment of endoscopically less than 2cm tumors, and discussed the safety and efficacy of endoscopic submucosal excision in the treatment of tumors with less than 2cm in the lamina propria muscularis of digestive tract. Methods the clinical data of 55 patients with intramuscular lamina propria smaller than 2cm tumor treated with ESE in our hospital from 2013 to 2016 were analyzed retrospectively. The occurrence and management of complications were observed during the operation, the histopathological examination and immunohistochemical examination were performed in the resected specimens, and the endoscopic follow-up was carried out after operation. To determine the type, location, resection rate, incidence of complications, cause and treatment of complications, average hospitalization days and hospitalization expenses of ESE, pathological and immunohistochemical results after operation, and to analyze the pathological and immunohistochemical results of the treatment of myometrium propria tumor, the location of the tumor, the rate of mass resection, the incidence of complications and the treatment measures. To grade the pathological changes of stromal tumors, to score some patients with anxiety and depression before and after operation, to analyze and arrange all clinical data, to follow up by gastroscopy or ultrasound gastroscopy after operation. The healing, local residue and recurrence of lesions were observed, and a conclusion was drawn. Results of 55 cases, 54 cases were completely resected under gastroscopy. The mean time of ESE operation was 40.96 卤17.84 mins. The average hospitalization days were 12.95 卤5.72 days and the average hospitalization expenses were 13163.17 卤7333.72 yuan. There were 10 cases of perforation during operation, the incidence of perforation was 18.210 / 55, the wound was closed with titanium clip or OTSC during the wound operation, and after conservative treatment such as gastrointestinal decompression, acid suppression and fluid resuscitation, no cases were transferred to surgery and there were no death cases. The bleeding was stopped by endoscopy, such as epinephrine spraying, APC electrocoagulation or titanium clip occlusion. Delayed hemorrhage occurred in 1 case after operation. Postoperative pathological diagnosis showed that there were 1 Glomus tumor, 25 leiomyoma, 1 hemangioma, 1 neurilemmoma and 27 stromal tumors. Pathological and immunohistochemical findings of stromal tumors, according to the classification standard of gastrointestinal stromal tumors (2008), the risk classification: very low risk in 18 cases, low risk in 7 cases, moderate risk in 2 cases. The cutting margin was negative. All the patients were followed up by gastroscopy after operation. The healing of the original operation area was good. There were significant differences in the scores of anxiety self-rating and depression self-rating scale before and after operation in 15 patients without tumor residue and recurrence (P 0.001). Preoperative anxiety and depression scores were significantly higher than postoperative scores. Conclusion ESE therapy has the characteristics of less trauma, faster recovery and less aggravation than 2cm, and can relieve anxiety of the patients.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735

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