改良内镜下黏膜结扎剥离术治疗胃固有肌层肿瘤临床价值分析.pdfVIP

．——446·—— ·论著· 改良内镜下黏膜结扎剥离术治疗 胃固有肌层肿瘤临床价值分析 贺德志 李建生徐海莉 周琳彭俏 陈文霞 【摘要】 目的探讨改良的内镜下结扎剥离术(ESD—L)对胃固有肌层小肿瘤的治疗价值。方 法对经超声胃镜检查证实来源于胃固有肌层、直径≤12mm的黏膜下肿瘤(SMT)60例，先行应用 常规ESD术剥离至固有肌层深部后，继而对瘤体及其底部固有肌层充分结扎，结扎后继续剥离直至 完整剥离瘤体。随访观察治疗效果。结果60例病变伞部完整切除，10例出现穿孔，行全层切除后 金属止血夹封闭创面，未转外科手术，无其他并发症发生。60例均获得病理诊断，随访期内未见复发 病例。结论应用剥离后结扎再剥离的改良ESD—L术治疗来源于同有肌层的SMT既能达到完全剥 离，减少病灶残留的治疗目的，又能降低凶实施全层切除而导致胃壁穿孔的风险。 【关键词】结扎术；内镜黏膜F剥离术；黏膜F肿瘤；固有肌层；治疗 Modified submucasaldissectionwith forsmall Uors from endoscopic iigation otisnatedgastric muscularisHE Wen-xia．De- propriaDe—zhi，12Jian—sheng，XUHai—li．ZHOULin，PENGQiao，CHEN First partmentofGastroenterology，theAffiliatedHospitalofZhengzhouUnwers∞,，Zhengzhou450052，China a脚hor：12 CorrespondingJian—sheng．Email：lijiansheng@medmail．c帆．cn To the valueofmodified submucosaldissec- 【Abstract】Objectiveexploretherapeutic endoscopic tionwinl smalltumom from muscularis To“of ligation(ESD—L)forori画n8tedgas啊c pmpria．Methods 60 withtumors from muscularis WaSconfirmed ultra- patients originatedgastric propria，which byendoscopic andsmallerthan12nllnandwererecruitedtothe conventionalESD sonography presentstudy．The technique WasusedtOdissectthetumortOthe ofmuscularis thebottomofthetumorandthebe· depth propria．Then neathmusculariswere witha dissectionwag tillthewhole pmpfialigatedfully nylonloop．Further applied tumorWaSisolated．ResultsAU60lesionsweredissected witIl occurredin10c褐es． completelyperforation whichwere metal Wa$obtainedinalllesions．and managedsuccessful