Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China.
Department of Gastroenterology, Lishui People's Hospital, Lishui, Zhejiang, China.
Surg Endosc. 2019 Sep;33(9):2880-2885. doi: 10.1007/s00464-018-6585-2. Epub 2018 Nov 19.
Endoscopic full-thickness resection (EFTR) has shown great prospects in treating gastric submucosal tumors (SMTs) from the muscularis propria. However, it is very difficult sometimes to ideally expose the tumor and gain adequate visualization for the dissection site. In the present study, we applied the thread-traction (TT) method to assist EFTR in treating gastric SMTs and investigated the feasibility and effectiveness of this strategy.
A total of 28 patients were involved in the study. 13 patients were treated by TT-assisted EFTR (TT group) and the others by non-assisted EFTR (NA group). Data on clinical characteristics and therapeutic outcomes were collected for analysis.
The average tumor size was 1.6 ± 0.4 cm. En bloc resection rate was 92.9%. Histopathological evaluation indicated that 22 tumors were gastrointestinal stromal tumors (78.6%), all at low- or very low-risk, and 6 tumors were leiomyomas (21.4%). The total complication rate was 32.1%. All complications were managed intra-operatively or conservatively. Both the total procedure time and the perforation time were significantly shorter in patients of TT group than those of NA group (71.9 ± 30.5 vs. 107.5 ± 35.8 min, P = 0.010; 38.3 ± 22.0 vs. 68.6 ± 24.2 min, P = 0.002). The pain score evaluated by visual analogue system after operation was significantly lower in patients of TT group than those of NA group (4.5 ± 1.1 vs. 5.8 ± 1.4, P = 0.014). Although complication rate was lower in patients of TT group than those of NA group, the difference was not statistically significant (15.4% vs. 46.7%, P = 0.114). No residual or recurrent tumors were observed during a mean follow-up period of 17.9 ± 4.4 months.
The TT method could effectively assist EFTR to shorten operation time and decrease the risk of complications.
内镜全层切除术（EFTR）在治疗来源于固有肌层的胃黏膜下肿瘤（SMT）方面显示出巨大的前景。然而，有时要理想地暴露肿瘤并获得足够的解剖部位可视化是非常困难的。在本研究中，我们应用线牵引（TT）方法辅助 EFTR 治疗胃 SMT，并研究了该策略的可行性和有效性。
共有 28 名患者参与了这项研究。其中 13 名患者接受 TT 辅助 EFTR 治疗（TT 组），其余患者接受非辅助 EFTR 治疗（NA 组）。收集了临床特征和治疗结果的数据进行分析。
肿瘤平均大小为 1.6±0.4cm。整块切除率为 92.9%。组织病理学评估表明，22 个肿瘤为胃肠道间质瘤（78.6%），均为低风险或极低风险，6 个肿瘤为平滑肌瘤（21.4%）。总的并发症发生率为 32.1%。所有并发症均在术中或保守治疗中得到处理。TT 组的总手术时间和穿孔时间均明显短于 NA 组（71.9±30.5 比 107.5±35.8 分钟，P=0.010；38.3±22.0 比 68.6±24.2 分钟，P=0.002）。TT 组患者术后视觉模拟评分系统评估的疼痛评分明显低于 NA 组（4.5±1.1 比 5.8±1.4，P=0.014）。虽然 TT 组的并发症发生率低于 NA 组，但差异无统计学意义（15.4%比 46.7%，P=0.114）。在平均 17.9±4.4 个月的随访期间，未观察到残留或复发肿瘤。
TT 方法可有效辅助 EFTR，缩短手术时间，降低并发症风险。
