胃固有肌层间质瘤内镜切除术的研究及临床应用

发布时间：2018-05-18 00:41

本文选题：内镜切除术 + 间质瘤　；参考：《青岛大学》2017年硕士论文

【摘要】：目的:探究内镜下切除胃固有肌层间质瘤的疗效与安全性。方法:选取2015年9月至2016年12月于青岛大学附属烟台毓璜顶医院消化内镜中心行普通胃镜检查发现的粘膜下病变,经超声胃镜、腹部CT检查提示胃固有肌层间质瘤的30例患者,所有患者均在气管插管静脉复合麻醉下行内镜下切除术治疗,包括内镜粘膜下挖除术(endoscopic submucosal excavation,ESE)以及内镜全层切除术(endoscopic full-thickness resection,EFR),术后随访评价其疗效及安全性。选取的30例患者符合以下要求:⑴EUS提示病变来源于胃壁固有肌层,显示低回声;⑵肿瘤最大直径3.5cm;⑶肿瘤边界清晰,包膜完整且内部回声均匀;⑷腔内生长型肿瘤;⑸CT及增强CT未发现周围淋巴结及其他脏器转移等提示恶变倾向。其中男性患者17名,女性患者13名,平均年龄59.6岁(28-78岁)。术前对所有患者详细交代手术风险并签署相关的知情同意书,对手术本身的益处和风险均予以交代。病人应该在手术前一周禁止服用阿司匹林等药,并在手术前进行血常规、常规心电图等必要检查,另外患者需禁食水8-10小时。所有患者术后常规禁食、卧床休息1-2天,期间给予全肠道外营养,质子泵抑制剂抑酸、并常规使用抗生素治疗。所有行ESE及EFR治疗的患者,术后立即将完整切除的病变以福尔马林液固定送病理学检查。应该严密观察患者病情变化,术后均应观察有无消化道出血的表现,有无胸闷、气促、紫绀,有无腹痛、腹胀和腹膜炎体征,有无皮下气肿,必要时可给予胃肠减压、查X线胸片、立位腹平片。手术后第2-3天,无特殊不适,如出血、腹痛,可给予流质饮食,术后第3-4天,根据情况可给予半流质饮食。术后1、3、6、12个月来院复查电子胃镜,观察剥离后创面的愈合情况,金属夹有无脱落,必要时行超声胃镜检查病变有无复发,行CT及增强CT检查有无转移的情况。一般给予6-8周质子泵抑制剂,溃疡创面基本愈合。结果:30例来源于胃固有肌层的间质瘤均成功剥离,其中ESE切除22例,EFR切除8例,应用EFR切除者均予以金属钛夹成功夹闭。术后病理诊断:间质瘤,其中胃体8例,胃底18例,胃窦4例。病变最大直径0.5-3.5cm(平均2.2cm)。内镜切除操作时间30-180min(平均73.3min)。30例手术中均有少量出血,术后均未出现严重并发症。结论:内镜切除术治疗胃固有肌层间质瘤安全、有效,创伤小,整体切除率高,具有较好的临床推广价值。
[Abstract]:Objective: to investigate the efficacy and safety of endoscopic resection of intramuscular stromal tumors of the stomach. Methods: from September 2015 to December 2016, 30 patients with intramuscular stromal tumors (GIST) were examined by general gastroscopy at the Center of Digestive Endoscopy, Yantai Yuzhouding Hospital, affiliated to Qingdao University. Ultrasonic gastroscopy and abdominal CT examination showed that 30 patients had intramuscular stromal tumors of the stomach. All patients were treated by endoscopic submucosal excision under endotracheal intubation combined with anesthesia, including endoscopic submucosal excision and endoscopic full-thickness resection. The efficacy and safety of endoscopic full-thickness resection were evaluated. The 30 patients met the following requirement: 1 EUS indicated that the lesion originated from the lamina propria muscularis of the gastric wall, and showed that the maximum diameter of the hypoechoic tumor was 3.5 cm ~ (-3), the envelope was intact and the internal echo was homogenous. 5CT and contrast-enhanced CT showed no evidence of metastasis of peripheral lymph nodes and other organs. There were 17 male patients and 13 female patients, with an average age of 59.6 years and 28 to 78 years old. All patients were given a detailed account of the operation risk and signed the relevant informed consent, and the benefits and risks of the operation were explained. Patients should be banned from taking aspirin or other drugs one week before surgery, blood tests, routine electrocardiograms, and 8-10 hours fasting water before surgery. All patients were given total parenteral nutrition proton pump inhibitor acid suppression and antibiotic therapy. All patients treated with ESE and EFR were treated with formalin solution for pathological examination immediately after operation. We should closely observe the changes of the patient's condition, and observe whether there are signs of gastrointestinal bleeding, chest tightness, shortness of breath, cyanosis, abdominal pain, abdominal distension and peritonitis signs, subcutaneous emphysema, and gastrointestinal decompression if necessary. X-ray chest radiography, vertical abdominal plain film. After operation 2-3 days, no special discomfort, such as bleeding, abdominal pain, can be given a fluid diet, 3-4 days after the operation, according to the situation can be given a semi-fluid diet. In the past 12 months, the wound healing after exfoliation was observed, the metal clamp was removed or not, the recurrence of lesions was examined by ultrasound gastroscopy, and CT and enhanced CT were performed to examine the metastasis. Generally given 6-8 weeks proton pump inhibitor, ulcer wound healing. Results all 30 cases of stromal tumors derived from the lamina propria of the stomach were successfully dissected, including 22 cases of ESE resection and 8 cases of EFR resection. Postoperative pathological diagnosis: stromal tumor, including 8 cases of gastric body, 18 cases of fundus, 4 cases of antrum. The maximum diameter of lesion was 0.5-3.5 cm (mean 2.2 cm). The operative time of endoscopic resection was 30-180 mins (mean, there was a small amount of bleeding in 73.3min).30 patients, and no serious complications occurred after operation. Conclusion: endoscopic excision is safe, effective, less invasive and has high overall resection rate in the treatment of intramuscular stromal tumors of the stomach.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.2

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