本文選題：固有肌層腫瘤 + 內(nèi)鏡粘膜下挖除術(shù)�。� 參考：《安徽醫(yī)科大學(xué)》2017年碩士論文

【摘要】：研究背景與目的消化道固有肌層腫瘤常常在胃鏡檢查中偶然發(fā)現(xiàn),大部分病變?yōu)榱夹?但是也有一部分病變是惡性或者是潛在惡性,對此類病變尤其是病理為間質(zhì)瘤的治療主要包括手術(shù)治療,藥物治療,以及通過內(nèi)鏡定期觀察病變變化,然而對于內(nèi)鏡治療并無明確指證,尤其缺乏對于臨床常見的小于2cm病變治療可行性的研究資料。本研究通過分析內(nèi)鏡治療固有肌層小于2cm腫瘤的臨床資料,探討內(nèi)鏡黏膜下挖除術(shù)(endoscopic submucosal excavation,ESE)治療消化道固有肌層小于2cm腫瘤安全性及有效性,制定本地區(qū)治療診療規(guī)范。方法回顧性分析2013年-2016年在我院接受ESE治療的55例固有肌層小于2cm腫瘤患者的臨床資料。手術(shù)操作過程中中觀察并發(fā)癥發(fā)生及處理方案,切除標(biāo)本常規(guī)行病理組織學(xué)檢查及免疫組化檢查,術(shù)后進行內(nèi)鏡隨訪。明確我院ESE治療固有肌層腫瘤類型,腫瘤所在部位、整塊切除率、并發(fā)癥發(fā)生率,分析并發(fā)癥原因及治療措施,統(tǒng)計平均住院日及住院費用;術(shù)后分析病理、免疫組化結(jié)果,對病理為間質(zhì)瘤的病變進行危險度分級;通過焦慮抑郁量表對部分患者術(shù)前與術(shù)后焦慮抑郁進行評分,分析整理所有臨床數(shù)據(jù);術(shù)后通過胃鏡或超聲胃鏡檢查進行隨訪,觀察病變區(qū)域愈合,局部殘留及復(fù)發(fā)情況,從而得出結(jié)論。結(jié)果55例病變其中54例病變均在胃鏡下完整切除,其中1例因術(shù)中發(fā)現(xiàn)瘤體過大轉(zhuǎn)入外科手術(shù)。ESE手術(shù)時間為42-102min,平均時間70.96±17.84min。平均住院日12.95±5.72d,平均住院費用13163.17±7333.72元。術(shù)中發(fā)生穿孔10例,穿孔發(fā)生率18.2%(10/55),創(chuàng)面術(shù)中予以鈦夾或OTSC夾閉創(chuàng)面;術(shù)后經(jīng)胃腸減壓、抑酸、補液等保守治療后,無病例轉(zhuǎn)入外科手術(shù)治療且無死亡病例;術(shù)中均有不同程度滲血,經(jīng)內(nèi)鏡下止血如腎上腺素噴灑、內(nèi)鏡下熱活鉗、APC電凝或鈦夾夾閉后等出血停止。術(shù)后遲發(fā)性出血1例。術(shù)后病理診斷提示血管球瘤1例,平滑肌瘤25例;血管瘤1例;神經(jīng)鞘瘤1例;間質(zhì)瘤27例。其中病理及免疫組化提示間質(zhì)瘤的病變,根據(jù)胃腸間質(zhì)瘤分級標(biāo)準(zhǔn)(2008)危險度分級:極低危險度18例,低危險度7例,中度危險度2例。切緣均為陰性。所有患者術(shù)后通過胃鏡復(fù)查隨訪,原手術(shù)區(qū)域愈合可,未發(fā)現(xiàn)腫瘤殘留及復(fù)發(fā)。15例患者術(shù)前及術(shù)后焦慮自評量得分及抑郁自評量表得分差異均具有統(tǒng)計學(xué)意義(P0.001)。術(shù)前焦慮及抑郁評分均明顯高于術(shù)后得分。結(jié)論ESE治療對于小于2cm固有肌層病變具有創(chuàng)傷小,恢復(fù)快,避免病變進一步惡化的特點,并且可以緩解患者焦慮情緒。
[Abstract]:Background and objective Gastrointestinal muscularis propria tumors are often found by chance in gastroscopy. Most lesions are benign, but others are malignant or potentially malignant. The treatment of such lesions, especially pathological stromal tumors, includes surgical treatment, drug therapy, and regular observation of lesions through endoscopy, but there is no clear indication of endoscopic therapy. In particular, there is a lack of research data on the clinical feasibility of treatment of lesions less than 2cm. In this study, we analyzed the clinical data of endoscopic treatment of endoscopically less than 2cm tumors, and discussed the safety and efficacy of endoscopic submucosal excision in the treatment of tumors with less than 2cm in the lamina propria muscularis of digestive tract. Methods the clinical data of 55 patients with intramuscular lamina propria smaller than 2cm tumor treated with ESE in our hospital from 2013 to 2016 were analyzed retrospectively. The occurrence and management of complications were observed during the operation, the histopathological examination and immunohistochemical examination were performed in the resected specimens, and the endoscopic follow-up was carried out after operation. To determine the type, location, resection rate, incidence of complications, cause and treatment of complications, average hospitalization days and hospitalization expenses of ESE, pathological and immunohistochemical results after operation, and to analyze the pathological and immunohistochemical results of the treatment of myometrium propria tumor, the location of the tumor, the rate of mass resection, the incidence of complications and the treatment measures. To grade the pathological changes of stromal tumors, to score some patients with anxiety and depression before and after operation, to analyze and arrange all clinical data, to follow up by gastroscopy or ultrasound gastroscopy after operation. The healing, local residue and recurrence of lesions were observed, and a conclusion was drawn. Results of 55 cases, 54 cases were completely resected under gastroscopy. The mean time of ESE operation was 40.96 鹵17.84 mins. The average hospitalization days were 12.95 鹵5.72 days and the average hospitalization expenses were 13163.17 鹵7333.72 yuan. There were 10 cases of perforation during operation, the incidence of perforation was 18.210 / 55, the wound was closed with titanium clip or OTSC during the wound operation, and after conservative treatment such as gastrointestinal decompression, acid suppression and fluid resuscitation, no cases were transferred to surgery and there were no death cases. The bleeding was stopped by endoscopy, such as epinephrine spraying, APC electrocoagulation or titanium clip occlusion. Delayed hemorrhage occurred in 1 case after operation. Postoperative pathological diagnosis showed that there were 1 Glomus tumor, 25 leiomyoma, 1 hemangioma, 1 neurilemmoma and 27 stromal tumors. Pathological and immunohistochemical findings of stromal tumors, according to the classification standard of gastrointestinal stromal tumors (2008), the risk classification: very low risk in 18 cases, low risk in 7 cases, moderate risk in 2 cases. The cutting margin was negative. All the patients were followed up by gastroscopy after operation. The healing of the original operation area was good. There were significant differences in the scores of anxiety self-rating and depression self-rating scale before and after operation in 15 patients without tumor residue and recurrence (P 0.001). Preoperative anxiety and depression scores were significantly higher than postoperative scores. Conclusion ESE therapy has the characteristics of less trauma, faster recovery and less aggravation than 2cm, and can relieve anxiety of the patients.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735

【參考文獻】

相關(guān)期刊論文 前10條

1 王敬齋;張樹榮;;Zung焦慮抑郁自評量表對消化內(nèi)科門診患者焦慮抑郁的測評[J];臨床消化病雜志;2016年03期

2 Edris Wedi;Susana Gonzalez;Detlev Menke;Elena Kruse;Kai Matthes;Juergen Hochberger;;One hundred and one over-the-scope-clip applications for severe gastrointestinal bleeding, leaks and fistulas[J];World Journal of Gastroenterology;2016年05期

3 方華鎣;張開光;張明黎;王業(yè)濤;茍雅雯;呂超藍;宋繼中;葉飛;余躍;;內(nèi)鏡黏膜下挖除術(shù)及隧道腫瘤切除術(shù)在食管間葉源性瘤治療中的應(yīng)用[J];安徽醫(yī)藥;2015年12期

4 莊端明;王小平;呂瑛;;內(nèi)鏡超聲對胃間質(zhì)瘤侵襲危險性的預(yù)測價值[J];胃腸病學(xué);2015年09期

5 許威;李三黨;韓曉鵬;李洪濤;孔延龍;蘇琳;劉宏斌;;雙鏡聯(lián)合手術(shù)治療胃間質(zhì)瘤93例療效分析[J];中國實用外科雜志;2015年04期

6 楊莉;李勝昔;徐美東;王燕慶;馬超;;內(nèi)鏡黏膜下剝離術(shù)及全層切除術(shù)治療胃黏膜下腫瘤的臨床療效分析[J];中國內(nèi)鏡雜志;2015年01期

7 鄧磊;于勁;樊超強;廖忠莉;謝霞;聶緒彪;彭學(xué);楊歆;滕冬梅;楊仕明;柏健鷹;;內(nèi)鏡黏膜下隧道剝離術(shù)治療食管固有肌層腫瘤的效果評價[J];第三軍醫(yī)大學(xué)學(xué)報;2014年24期

8 Liu-Ye Huang;Jun Cui;Cheng-Rong Wu;Bo Zhang;Li-Xin Jiang;Xiang-Shu Xian;Shu-Juan Lin;Ning Xu;Xiao-Ling Cao;Zhi-Hua Wang;;Endoscopic full-thickness resection and laparoscopic surgery for treatment of gastric stromal tumors[J];World Journal of Gastroenterology;2014年25期

9 牟一;胡兵;;內(nèi)鏡下胃部胃腸道間質(zhì)瘤切除適應(yīng)證之華西經(jīng)驗[J];中華消化內(nèi)鏡雜志;2014年05期

10 王穎;李艷霞;羅和生;于紅剛;;內(nèi)鏡黏膜下挖除術(shù)治療胃胃腸間質(zhì)瘤的療效分析[J];中華胃腸外科雜志;2014年04期

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