内镜下胃黏膜全层切除治疗胃间质瘤技术的临床应用

目的探讨经内镜下胃黏膜全层切除治疗胃间质瘤的临床应用。方法回顾性分析我科2012年经超声内镜确诊为胃间质瘤（GSTs）的30例患者的临床资料，根据肿瘤来源位置选择不同的内镜切除方法：（1）定位：氩气刀在EUS内镜超声扫描确定的病变周围5mm位置行环形定位；（2）注射：根据病变位置选择不同的注射方法①对来源于胃黏膜肌层的间质瘤，于黏膜下注适量的水；②对来源于胃固有肌层的间质瘤，不行注水处理；（3）切除：①对来源于胃黏膜肌层的间质瘤，采用透明帽法行黏膜切除；②对来源于胃固有肌层的间质瘤，纵行切开肿瘤表面，再根据病变直径运用不同的办法切除；（4）创面充分止血、缝合创面。结果术前超声提示18例来源于固有肌层，12例来源于黏膜肌层。30例均成功切除病灶，病灶位于胃底5例，胃窦15例，胃体10例，病变平均直径为（10±3．1）mm，病理结果证实胃间质瘤27例，平滑肌瘤3例。结论内镜下胃黏膜全层切除术治疗胃间质瘤具有创伤小，恢复快，并发症发生率低等特点。

Clinical application of endoscopic gastric full-thickness resection to gastric stromal tumors

Objective To research the clinical application of endoscopic gastric full-thickness resection to gastric stromal tumors （GSTs）. Methods Retrospective analysis was done on 30 cases of GSTs diagnosed by endoscopic ultrasound in our department in 2012. According to tumor＇ s primary location, different endoscopic resections were selected, i.e. （ 1 ） Location： to locate around the lesion within 5mm by argon plasma coagulation. （2） Injection： basing on the location of the lesion, to choose a different meth- od ： （1）Injeeting an appropriate amount of water to the bottom of the mucosa with regard to the GSTs from museularis mucosae ; （2）Not needing injection with regard to the GSTs from muscularis propria. （ 3 ） Excision ： （1）Using transparent cap method of mueosal resec- tion with the GSTs from muscularis mueosae ; （2）For the GSTs from muscularis propria, after longitudinal excision of the surface of the tumor, choosing a different method to mueosal resection basing with the diameter of lesion. （4） Wound surface homeostasis and suture. Results Of the 30 cases, 18 were preoperatively diagnosed by endoscopic ultrasound that the lesions were from muscularis propria and 12 from muscularis mucosae. They were all successful in resection of the lesions, with 5 cases of gastric fundus, 15 ca- ses of gastric antrum and 10 cases of gastric body. The average diameter of the lesions was （ 10 ± 3.1 ） mm, and the pathological findings confirmed that 27 cases were GSTs and 3 cases were gastric leiomyoma. Conclusion With less trauma, quick recovery and low rate of complication, it is suggested that endoscopic gastric full-thickness resection is used in GSTs.