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目的探讨超声内镜(EUS)对预测胃肠道粘膜下间质瘤(GIST)内镜下全层切除术(EFTR)安全性评估的价值。方法 2013年12月至2014年6月86例胃粘膜下肿瘤且术后病理证实为间质瘤的患者,EFTR术前均行EUS检查。EUS探查黏膜下血管结构及粘膜下肿瘤大小、形态、边界以及起源的层次。肿瘤旁探查每个视野有一支血管直径超过500μm,或探查见每个视野有3支血管直径200~500μm为富血供组(R组,40例),否则为乏血供组(N组,46例)。回顾性分析手术时间、血红蛋白减少程度、钛夹止血的使用率、并发症、复发率等资料。结果R组手术时间明显长于N组[(65.2±20.2)min vs(40.8±19.6)min,P<0.05]。R组血管损伤的发生率和钛夹止血使用率分别为92.5%和100%,均明显高于N组的17.4%和19.6%(P均<0.01)。两组血红蛋白降低程度、12个月的随访结果比较无差异。结论超声内镜术前探查胃粘膜下间质瘤的血管结构可以预测手术时间、血管损伤后热钳和钛夹止血的使用率,特别适用于EFTR的安全性预测并为治疗方案提供信息。
Objective To investigate the value of endoscopic ultrasonography (EUS) in assessing the safety of endoscopic subtotal gastrectomy (EFTR) in the diagnosis of gastrointestinal submucosal tumor (GIST). Methods Twenty-six patients with gastric submucosal tumors from December 2013 to June 2014 with pathologically confirmed stromal tumors were examined with EUS before EFTR. EUS probe submucosal vascular structure and submucosal tumor size, morphology, boundaries and the origin of the level. Next to the tumor, there is a blood vessel diameter of more than 500μm in each field of vision, or 3 blood vessels of 200-500μm in each field of exploration are rich blood supply group (R group, 40 cases) 46 cases). Retrospective analysis of operation time, the degree of hemoglobin reduction, titanium clip hemostasis, complications, recurrence rate and other data. Results The operation time of group R was significantly longer than that of group N [(65.2 ± 20.2) min vs (40.8 ± 19.6) min, P <0.05]. The incidence of vascular injury and titanium clip hemostasis in the R group were 92.5% and 100%, respectively, which were significantly higher than those in the N group (17.4% vs 19.6%, P <0.01). Two groups of hemoglobin decreased, 12-month follow-up results were no difference. Conclusions Ultrasound endoscopy preoperatively to explore the vascular structure of gastric submucosal tumors can predict the operation time, the use of heat clamp and titanium clip after blood vessel injury, especially for the safety prediction of EFTR and provide information for the treatment plan.