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目的:总结分析内镜下粘膜剥离术(Endoscopic Submucosal Dissection,ESD)治疗胃间质瘤的临床疗效和安全性评价。方法:收集2009年4月至2016年2月我院因胃间质瘤行ESD治疗患者的临床资料,分析其临床疗效及安全性。结果:我院2009年4月至2016年2月完成ESD治疗胃间质瘤22例,其中位于胃底19例,底体交界2例,胃体1例,肿瘤平均直径1.28cm,大于2cm者共5例;除1例转外科切除外,其余21例均内镜下彻底剥离,内镜下切除率达95.45%;所有患者术中出血量均在50毫升以下,术后无1例呕血、黑便;13例术中发生穿孔(穿孔率59%),1例穿孔后转外科手术切除肿瘤并闭合穿孔,其他12例均在内镜下修补穿孔。术后病理示1例高度危险性,2例中度危险性,19例低度危险性,随访3个月至3年,无1例复发或转移。结论:ESD治疗胃间质瘤内镜下切除率高,疗效肯定。术中穿孔为常见并发症,多可内镜下修补,无需转外科手术。
Objective: To summarize the clinical efficacy and safety evaluation of endoscopic submucosal dissection (ESD) in the treatment of gastric stromal tumors. Methods: The clinical data of patients with gastric stromal tumor undergoing ESD treatment from April 2009 to February 2016 were collected and their clinical efficacy and safety were analyzed. Results: From April 2009 to February 2016, 22 cases of gastric stromal tumors were treated with ESD. Among them, 19 were located in the fundus, 2 in the junction of the basal body, 1 in the corpus, 1.28 cm in diameter and more than 2 cm in diameter A total of 5 cases; in addition to 1 case of surgical excision, the remaining 21 cases were completely stripped endoscopic endoscopic resection rate was 95.45%; all patients were less than 50 ml of blood loss, no postoperative hematemesis, Melena; 13 cases of perforation occurred (perforation rate of 59%), a case of perforation after surgical removal of the tumor and closed perforation, the other 12 cases were repaired in the endoscopic perforation. Postoperative pathology showed 1 case of high risk, 2 cases of moderate risk, 19 cases of low risk, followed up for 3 months to 3 years, none of the recurrence or metastasis. Conclusion: Endoscopic resection of gastric stromal tumor with ESD is safe and effective. Intraoperative perforation is a common complication, mostly endoscopic repair, no need to go to surgery.