本文選題：內(nèi)鏡切除術(shù) + 間質(zhì)瘤��； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的:探究?jī)?nèi)鏡下切除胃固有肌層間質(zhì)瘤的療效與安全性。方法:選取2015年9月至2016年12月于青島大學(xué)附屬煙臺(tái)毓璜頂醫(yī)院消化內(nèi)鏡中心行普通胃鏡檢查發(fā)現(xiàn)的粘膜下病變,經(jīng)超聲胃鏡、腹部CT檢查提示胃固有肌層間質(zhì)瘤的30例患者,所有患者均在氣管插管靜脈復(fù)合麻醉下行內(nèi)鏡下切除術(shù)治療,包括內(nèi)鏡粘膜下挖除術(shù)(endoscopic submucosal excavation,ESE)以及內(nèi)鏡全層切除術(shù)(endoscopic full-thickness resection,EFR),術(shù)后隨訪評(píng)價(jià)其療效及安全性。選取的30例患者符合以下要求:⑴EUS提示病變來源于胃壁固有肌層,顯示低回聲;⑵腫瘤最大直徑3.5cm;⑶腫瘤邊界清晰,包膜完整且內(nèi)部回聲均勻;⑷腔內(nèi)生長(zhǎng)型腫瘤;⑸CT及增強(qiáng)CT未發(fā)現(xiàn)周圍淋巴結(jié)及其他臟器轉(zhuǎn)移等提示惡變傾向。其中男性患者17名,女性患者13名,平均年齡59.6歲(28-78歲)。術(shù)前對(duì)所有患者詳細(xì)交代手術(shù)風(fēng)險(xiǎn)并簽署相關(guān)的知情同意書,對(duì)手術(shù)本身的益處和風(fēng)險(xiǎn)均予以交代。病人應(yīng)該在手術(shù)前一周禁止服用阿司匹林等藥,并在手術(shù)前進(jìn)行血常規(guī)、常規(guī)心電圖等必要檢查,另外患者需禁食水8-10小時(shí)。所有患者術(shù)后常規(guī)禁食、臥床休息1-2天,期間給予全腸道外營(yíng)養(yǎng),質(zhì)子泵抑制劑抑酸、并常規(guī)使用抗生素治療。所有行ESE及EFR治療的患者,術(shù)后立即將完整切除的病變以福爾馬林液固定送病理學(xué)檢查。應(yīng)該嚴(yán)密觀察患者病情變化,術(shù)后均應(yīng)觀察有無消化道出血的表現(xiàn),有無胸悶、氣促、紫紺,有無腹痛、腹脹和腹膜炎體征,有無皮下氣腫,必要時(shí)可給予胃腸減壓、查X線胸片、立位腹平片。手術(shù)后第2-3天,無特殊不適,如出血、腹痛,可給予流質(zhì)飲食,術(shù)后第3-4天,根據(jù)情況可給予半流質(zhì)飲食。術(shù)后1、3、6、12個(gè)月來院復(fù)查電子胃鏡,觀察剝離后創(chuàng)面的愈合情況,金屬夾有無脫落,必要時(shí)行超聲胃鏡檢查病變有無復(fù)發(fā),行CT及增強(qiáng)CT檢查有無轉(zhuǎn)移的情況。一般給予6-8周質(zhì)子泵抑制劑,潰瘍創(chuàng)面基本愈合。結(jié)果:30例來源于胃固有肌層的間質(zhì)瘤均成功剝離,其中ESE切除22例,EFR切除8例,應(yīng)用EFR切除者均予以金屬鈦夾成功夾閉。術(shù)后病理診斷:間質(zhì)瘤,其中胃體8例,胃底18例,胃竇4例。病變最大直徑0.5-3.5cm(平均2.2cm)。內(nèi)鏡切除操作時(shí)間30-180min(平均73.3min)。30例手術(shù)中均有少量出血,術(shù)后均未出現(xiàn)嚴(yán)重并發(fā)癥。結(jié)論:內(nèi)鏡切除術(shù)治療胃固有肌層間質(zhì)瘤安全、有效,創(chuàng)傷小,整體切除率高,具有較好的臨床推廣價(jià)值。
[Abstract]:Objective: to investigate the efficacy and safety of endoscopic resection of intramuscular stromal tumors of the stomach. Methods: from September 2015 to December 2016, 30 patients with intramuscular stromal tumors (GIST) were examined by general gastroscopy at the Center of Digestive Endoscopy, Yantai Yuzhouding Hospital, affiliated to Qingdao University. Ultrasonic gastroscopy and abdominal CT examination showed that 30 patients had intramuscular stromal tumors of the stomach. All patients were treated by endoscopic submucosal excision under endotracheal intubation combined with anesthesia, including endoscopic submucosal excision and endoscopic full-thickness resection. The efficacy and safety of endoscopic full-thickness resection were evaluated. The 30 patients met the following requirement: 1 EUS indicated that the lesion originated from the lamina propria muscularis of the gastric wall, and showed that the maximum diameter of the hypoechoic tumor was 3.5 cm ~ (-3), the envelope was intact and the internal echo was homogenous. 5CT and contrast-enhanced CT showed no evidence of metastasis of peripheral lymph nodes and other organs. There were 17 male patients and 13 female patients, with an average age of 59.6 years and 28 to 78 years old. All patients were given a detailed account of the operation risk and signed the relevant informed consent, and the benefits and risks of the operation were explained. Patients should be banned from taking aspirin or other drugs one week before surgery, blood tests, routine electrocardiograms, and 8-10 hours fasting water before surgery. All patients were given total parenteral nutrition proton pump inhibitor acid suppression and antibiotic therapy. All patients treated with ESE and EFR were treated with formalin solution for pathological examination immediately after operation. We should closely observe the changes of the patient's condition, and observe whether there are signs of gastrointestinal bleeding, chest tightness, shortness of breath, cyanosis, abdominal pain, abdominal distension and peritonitis signs, subcutaneous emphysema, and gastrointestinal decompression if necessary. X-ray chest radiography, vertical abdominal plain film. After operation 2-3 days, no special discomfort, such as bleeding, abdominal pain, can be given a fluid diet, 3-4 days after the operation, according to the situation can be given a semi-fluid diet. In the past 12 months, the wound healing after exfoliation was observed, the metal clamp was removed or not, the recurrence of lesions was examined by ultrasound gastroscopy, and CT and enhanced CT were performed to examine the metastasis. Generally given 6-8 weeks proton pump inhibitor, ulcer wound healing. Results all 30 cases of stromal tumors derived from the lamina propria of the stomach were successfully dissected, including 22 cases of ESE resection and 8 cases of EFR resection. Postoperative pathological diagnosis: stromal tumor, including 8 cases of gastric body, 18 cases of fundus, 4 cases of antrum. The maximum diameter of lesion was 0.5-3.5 cm (mean 2.2 cm). The operative time of endoscopic resection was 30-180 mins (mean, there was a small amount of bleeding in 73.3min).30 patients, and no serious complications occurred after operation. Conclusion: endoscopic excision is safe, effective, less invasive and has high overall resection rate in the treatment of intramuscular stromal tumors of the stomach.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.2

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本文編號(hào)：1903624