Kajiyama T, Hajiro K, Sakai M, Inoue K, Konishi Y, Takakuwa H, Ueda S, Okuma M
First Department of Internal Medicine, Kyoto University, Japan.
Gastrointest Endosc. 1996 Oct;44(4):404-10. doi: 10.1016/s0016-5107(96)70089-5.
Endoscopic diagnosis and treatment of gastrointestinal submucosal lesions is still not established. We evaluated the clinical usefulness of two resection methods for submucosal lesions, using a "nonrandomized surgeon" design.
The strip biopsy method was evaluated at Tenri Hospital and the aspiration lumpectomy method was used at Kyoto University Hospital. The inclusion criteria for selecting patients were endosonographic findings indicating a tumor location within the submucosa.
Seventy-seven patients were treated. The size of the specimens (mean +/- SEM) was 20.7 +/- 0.9 mm for the aspiration lumpectomy group and 14.0 +/- 0.8 mm for the strip biopsy group (p < 0.01). Aspiration lumpectomy was adequate for a definitive histologic diagnosis in 95% of the cases (36 of 38) as compared with 77% (30 to 39) of the cases treated by strip biopsy (p = 0.047). The eradication rate was 87% for the aspiration lumpectomy group, and 74% for the strip biopsy group (p = 0.274). The complication rate resulting from these procedures (hemorrhage, mean 5%) was acceptable. Repeated endoscopic examinations revealed no recurrence except for one lymphangioma.
Endoscopic resection, especially aspiration lumpectomy, provides a significant benefit for accurate final diagnosis and eradication of submucosal lesions.
胃肠道黏膜下病变的内镜诊断和治疗方法尚未确立。我们采用“非随机外科医生”设计评估了两种黏膜下病变切除方法的临床实用性。
在天理医院评估了条形活检法，在京都大学医院采用了吸引性肿块切除术。选择患者的纳入标准是内镜超声检查结果显示肿瘤位于黏膜下层。
共治疗了77例患者。吸引性肿块切除术组标本大小（均值±标准误）为20.7±0.9mm，条形活检组为14.0±0.8mm（p<0.01）。95%（38例中的36例）的吸引性肿块切除术病例通过该方法获得了明确的组织学诊断，而条形活检组这一比例为77%（39例中的30例）（p=0.047）。吸引性肿块切除术组的根除率为87%，条形活检组为74%（p=0.274）。这些手术引起的并发症发生率（出血，平均5%）是可以接受的。重复内镜检查显示，除1例淋巴管瘤外无复发。
内镜切除术，尤其是吸引性肿块切除术，对于准确的最终诊断和根除黏膜下病变具有显著益处。
