Endoscopic full-thickness resection without laparoscopic assistance for gastric submucosal tumors originated from the muscularis propria
Endoscopic full-thickness resection without laparoscopic assistance for gastric submucosal tumors originated from the muscularis propria
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DOI：
10.1007/s00464-011-1644-y
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发表时间：
2011-09-01
影响因子：
3.1
通讯作者：
Liu, Jing-Zheng
中科院分区：
文献类型：
--
作者：
Zhou, Ping-Hong;Yao, Li-Qing;Liu, Jing-Zheng
本研究旨在探讨胃镜下全层切除术(EFR)治疗胃黏膜下肿瘤(SMTs)的临床疗效、安全性和可行性。EFR技术包括5个主要步骤：(1)在黏膜下层注入生理盐水，并预先切断病变周围的粘膜和粘膜下层；(2)采用内窥镜下黏膜下剥离(ESD)技术，在病变周围进行深至固有肌层的环状切开；(3)用钩刀切开病变周围的浆膜层；(4)在胃镜下用钩子、IT或陷阱完成肿瘤的全层切开；(5)在没有腹腔镜辅助的情况下，用金属夹闭闭合胃壁缺损。手术完全切除率100%，手术时间60~145分钟，平均105分钟。病变切除面积1.2~4.5 cm，平均2.8 cm。病理诊断包括胃肠道间质瘤(GIST)(16/26)、平滑肌瘤(6/26)、血管球瘤(3/26)和神经鞘瘤(1/26)。EFR术后无胃出血、腹膜炎征象、腹壁脓肿发生。随访6~24个月，平均8个月，无病变残留或复发。EFR是治疗胃SMT的一种有效、安全、微创的治疗方法，可切除胃深部病变并提供准确的病理诊断。随着EFR的发展，内窥镜切除的适应证可能会扩大。
This study was designed to evaluate the clinical efficacy, safety, and feasibility of endoscopic full-thickness resection (EFR) for gastric submucosal tumors (SMTs) originated from the muscularis propria.Twenty-six patients with gastric SMTs originated from the muscularis propria were treated by EFR between July 2007 and January 2009. EFR technique consists of five major procedures: (1) injecting normal saline into the submucosa and precutting the mucosal and submucosal layer around the lesion; (2) a circumferential incision as deep as muscularis propria around the lesion by the endoscopic submucosal dissection (ESD) technique; (3) incision into serosal layer around the lesion with Hook knife; (4) completion of full-thickness incision to the tumor including the serosal layer with Hook, IT, or snare by gastroscopy without laparoscopic assistance; (5) closure of the gastric-wall defect with metallic clips.EFR was successfully performed in all 26 patients without laparoscopic assistance. The complete resection rate was 100%, and the mean operation time was 105 (range, 60-145) min. The mean resected lesion size was 2.8 (range, 1.2-4.5) cm. Pathological diagnosis of these lesions included gastrointestinal stromal tumors (GISTs) (16/26), leiomyomas (6/26), glomus tumors (3/26), and Schwannoma (1/26). No gastric bleeding, peritonitis sign, or abdominal abscess occurred after EFR. No lesion residual or recurrence was found during the follow-up period (mean, 8 months; range, 6-24 months).EFR seems to be an efficacious, safe, and minimally invasive treatment for patients with gastric SMT, which makes it possible to resect deep gastric lesion and provide precise pathological diagnosis of it. With the development of EFR, the indication of endoscopic resection may be expanded.