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目的:近年微创内镜技术作为治疗起源于固有肌层的黏膜下肿瘤的新型方式迅速发展。本研究旨在通过观察超声内镜下起源于固有肌层的肿瘤包膜完整性及所处位置(位于浅肌层或深肌层)、与浆膜层的位置关系和肿瘤与固有肌层紧密接触长度占肿瘤包膜长度的比例来评估完整切除率、穿孔及出血等并发症发生率、预后情况,进一步指导内镜下治疗方式的选择。创新点:首次提出通过超声内镜术前评估肿瘤包膜的完整性、在固有肌层中所处的位置及与固有肌层连接的长度选择内镜下治疗方式,可以提高完整切除率及降低术中并发症的发生。方法:收集浙江省人民医院及浙江省立同德医院2014年02月至2016年6月接受内镜治疗的胃固有肌层肿瘤患者资料,总结并分析其临床特点、内镜及超声内镜表现、临床结果及术后随访资料。结论:肿瘤包膜的完整性与完全切除率密切相关。起源于深肌层以及与固有肌层为宽连接的黏膜下肿瘤在内镜黏膜下剥离术(ESD)中穿孔可能性较大。通过超声内镜术前评估起源于固有肌层的胃黏膜下肿瘤包膜的完整性、所处的位置以及与固有肌层连接的长度,有助于提高完整切除率和减少术中并发症的发生。
OBJECTIVE: In recent years, minimally invasive endoscopic techniques have developed rapidly as a new way to treat submucosal tumors that originate in the muscularis propria. The purpose of this study was to observe the tumor envelope integrity and location (located in the superficial or deep muscularis propria) originating from the muscularis propria by endoscopic ultrasonography, the relationship with the serosa and the tight relationship between the tumor and the muscularis propria Contact length of the proportion of the length of the tumor capsule to assess the complete resection rate, complications such as perforation and bleeding incidence, prognosis, to further guide the choice of endoscopic treatment. Innovative point: The first proposed by endoscopic ultrasonography to assess the integrity of the tumor capsule, the location in the muscularis propria and the length of the muscle and the length of the choice of endoscopic treatment, can improve the complete resection rate and reduce Intraoperative complications occurred. Methods: The data of patients with gastric musculoskeletal tumors undergoing endoscopic treatment at Zhejiang Provincial People’s Hospital and Tongde Hospital of Zhejiang Province from February 2014 to June 2016 were collected, and their clinical features, endoscopic and endoscopic ultrasonography were collected , Clinical results and postoperative follow-up data. Conclusion: The integrity of tumor capsule is closely related to the rate of complete resection. Submucosal tumors, which originate in the deep myometrium and are extensively connected to the muscularis propria, are more likely to perforate in endoscopic submucosal dissection (ESD). Assessing the integrity of the gastric submucosal tumor capsule originating from the muscularis mucosa, its location, and the length of its attachment to the muscularis propria prior to endoscopic ultrasonography help improve the rate of complete resection and reduce intraoperative complications occur.