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目的探讨胃镜与腹腔镜双镜联合、内镜黏膜下挖除术(endoscopic submucosal excavation,ESE)及内镜黏膜下隧道肿瘤切除术(submucosal tunneling endoscopic resection,STER)治疗胃肠道间质瘤(GIST)的效果和安全性。方法经胃(肠)镜、超声内镜及病理学、免疫组化证实GIST患者86例,对其中53例患者采用ESE、29例患者采用胃镜与腹腔镜双镜联合、4例患者采用STER法进行瘤体切除。结果 ESE、双镜联合及STER治疗的所有患者均完整切除瘤体,术后风险评估极低危56例、低危17例、中危8例、高危5例。三种方法均无术中及术后迟发性出血、剧烈腹痛等并发症,瘤体位于贲门者切除后患者贲门功能保持良好,术后随访无反流性食管炎等并发症。术后随访有1例中危GIST患者因术后未服用格列卫发生盆腔转移,其他患者无远处转移及复发。结论胃镜与腹腔镜双镜联合技术、ESE及STER是治疗胃肠道间质瘤的微创、安全、有效的新方法。
Objective To investigate the relationship between endoscopic submucosal excavation (ESE) and submucosal tunneling endoscopic resection (STER) in the treatment of gastrointestinal stromal tumors (GIST) ) Effect and safety. Methods Totally 86 patients with GIST were confirmed by gastroscopy, endoscopic ultrasonography and pathology. Immunohistochemistry was performed on 53 patients with ESE. Twenty-nine patients underwent endoscopy combined with laparoscopic biopsies. Four patients underwent STER Tumor resection. Results All patients with ESE, dual mirror combined and STER had complete resection of the tumor. There were 56 cases with very low risk, 17 cases with low risk, 8 cases with moderate risk and 5 cases with high risk. None of the three methods were complicated by intraoperative and postoperative delayed hemorrhage, severe abdominal pain and other complications. The cardia function of the patients whose esophagus was located in the cardia was well maintained and no postoperative reflux esophagitis and other complications were observed. One case of GIST patients were followed up for pelvic metastases who did not take Gleevec after operation. Other patients did not have distant metastasis and recurrence. Conclusion Gastroscopy combined with laparoscopic double mirror, ESE and STER is a minimally invasive, safe and effective method for the treatment of gastrointestinal stromal tumors.