急性穿孔内镜闭合与腹腔镜修补的对照研究

The Control Study of Endoscopic Closure with Acute Perforation and Laparoscopic Repair

摘要: 目的：对于胃固有肌层肿瘤内镜黏膜下肿物挖除术(endoscopic submucosal excavation, ESE)和内镜全层切除术(endoscopic full thickness resection, EFR)术中治疗性穿孔，进行内镜闭合术和腹腔镜闭合的疗效比较，探讨急性穿孔的内镜闭合术的疗效和安全性。方法：2014年01月~2016年06月江南大学附属医院消化内镜中心经超声内镜(EUS)发现的起源于胃固有肌层的黏膜下肿瘤(SMTs)，内镜下切除ESE/EFR术中发生治疗性穿孔的病例，进行腹腔镜修补术与内镜闭合术各前20例病例。闭合方式：腹腔闭合术或内镜闭合术。结果：2组在手术耗时、医疗费用比较，P < 0.01，技术难度、风险比较，P > 0.05。ESE及EFR术后病理38例诊断为间质瘤，2例平滑肌瘤。其中胃底17例，胃体15例，胃窦8例。病变直径0.6~4.2 cm，平均直径1.8 cm。全组未出现术后出血，随访5~32个月，恢复良好，未出现复发或转移。结论：随着内镜闭合术的培训和技术进步，非腹腔镜辅助胃壁闭合术是安全、有效、患者术后恢复快，疗效较好。

Abstract: Objective: By comparing therapeutic perforation techniques to remove tumors in gastric muscula-ris propria through Endoscopic Submucosal Excavation (ESE) and Endoscopic Full-thickness Re-section (EFR), this thesis aims to make analysis on the curative effect on the technique of endoscopic closure and laparoscopic closure, and explore the effect and safety of acute perforation of the endoscopic closure technique. Methods: Analysis on the first 20 therapeutic cases of laparoscopic repair and endoscopic closure treatments to submucosal tumours (SMT) of the stomach removed through ESE/EFR, which were found by the Digestive Endoscopy Center of Affiliated Hospital of Jiangnan University under endoscopic ultrasonography (EUS) during Jan. 2014 to Jun. 2014. Method of Closure: Laparoscopic closure or endoscopic closure. Results: Significant difference is observed in operation time span and medical expenses in aforementioned two comparing groups (P < 0.01), while there is no significant difference in terms of technical difficulty and operational risk (P > 0.05). Postoperative pathology of 38 therapeutic cases operated through ESE and EFR was diagnosed as mesenchymal tumor and 2 cases as leiomyoma, among which 17 cases were in fundus ventriculi, 15 in corpus ventriculi and 8 in antrum. Lesion diameter varies from 0.6 cm to 4.2 cm with average diameter of 1.8 cm. No postoperative hemorrhage occurred in both 2 groups with satisfactory recovery in the post-surgery visits from 5 - 32 months neither recurrence or metastasis. Conclusion: With the training and technical progress of endoscopic closure, it is safe, effective and quick in recovery to have non-laparoscopic assisted surgery on gastric wall closure.