Value of preloaded suture with endoscopic submucosal dissection and full-thickness resection for thetreatment of gastric submucosal tumor

doi:10.3877/cma.j.issn.1674-0793.2019.05.012

Abstract

Abstract:

Objective

To investigate the value of preloaded sutured endoscopic submucosal dissection (ESD) and endoscopic full-thickness resection (EFR) for gastric submucosal tumors (GSMT).

Methods

From January 2014 to January 2018, seventy-two patients with GSMT of extraluminal growth type who underwent surgical treatment in XD Group Hospital were retrospectively analyzed. They were divided into observation group and control group according to the surgical method. Thirty-nine patients in the observation group underwent pre-loading suture before the lesion was perforated, followed by EFR. Thirty-three patients in the control group underwent perforation of the ESD conventional exfoliation lesions. The lesion size, operation time, postoperative complications, hospital stay, and postoperative recovery were compared between the two groups.

Results

The operation time of the observation group was (3.7±0.8) h,which was significantly lower than that of the control group (5.1±0.9) h, the difference was statistically significant (t=4.159, P=0.038). There were no differences in comparison of gastric tube indwelling time and hospitalization time between the two groups (t=0.605, 0.416, P=0.524, 0.702) . All patients underwent R0 resection successfully, 3 cases (7.69%) of the observation group had mild abdominal pain, and abdominal pain occurred in 6 cases (18.18%) of the control group. The incidence of postoperative complications in the observation group was significantly lower than that of the control group, the difference was statistically significant (χ²=6.373, P=0.012). One month after the operation, one case of wound ulcer occurred in the observation group and two cases in the control group, with no significant difference (χ²=0.348, P=0.555). All patients recovered two months after operation, and no obvious residual or recurrence symptoms appeared.

Conclusion

For the treatment of extracavity growing GSMT, endoscopic preloading suture with metal clip and nylon cord is reliable, which has a high clinical value because of shorter operation time, lower complication rate and rapid postoperative recovery.

Key words: Stomach neoplasms, Suture technique, Submucosal tumor, Preloaded suture

Wei Dong, Xiaofei Yang. Value of preloaded suture with endoscopic submucosal dissection and full-thickness resection for thetreatment of gastric submucosal tumor[J]. Chinese Archives of General Surgery(Electronic Edition), 2019, 13(05): 385-388.

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References 16

[1]	石磊，陈平，朱海杭，等. 内镜黏膜下剥离术及其衍生术在治疗胃黏膜下肿瘤中的应用[J]. 实用临床医药杂志, 2015, 19(3): 57-59.
[2]	诗涔，张欢，刘欢欢，等. 39例胃黏膜下肿瘤CT诊断[J]. 诊断学理论与实践, 2014，16(4): 393-397.
[3]	杨莉，李胜昔，徐美东，等. 内镜黏膜下剥离术及全层切除术治疗胃黏膜下肿瘤的临床疗效分析[J]. 中国内镜杂志, 2015, 21(1): 37-41.
[4]	王一卓，李红，张崴琪，等. 内镜黏膜下剥离术治疗上消化道黏膜下病变的疗效与并发症分析[J]. 胃肠病学和肝病学杂志, 2015, 24(5): 519-521.
[5]	凌鑫，汤金海，朱虹，等. 使用和谐夹的改良单钳道内镜下荷包缝合术的临床应用[J]. 中华消化内镜杂志, 2017, 34(1): 52-54.
[6]	徐佳昕，时强，周平红. 内镜下全层切除术治疗胃黏膜下肿瘤的技术进展[J]. 中华消化内镜杂志, 2015, 32(1): 63-65.
[7]	徐敏，朱艺艺，张永，等. 荷包缝合术在ESD术中的应用价值[J/CD]. 临床医药文献电子杂志, 2016, 3(57): 11351.
[8]	Suzuki H, Oda I, Abe S, et al. High rate of 5-year survival among patients with early gastric cancer undergoing curative endoscopic submucosal dissection[J]. Gastric Cancer, 2016, 19(1): 198-205.
[9]	Imai K, Hotta K, Yamaguchi Y, et al. Preoperative indicators for failure of en bloc resection or perforation in colorectal endoscopic submucosal dissection: implications for lesion stratification by technical difficulties during stepwise training[J]. Gastrointest Endosc, 2016, 83(5): 954-962.
[10]	Okada H. Clinical approach for gastric submucosal tumors of 2 cm or less in diameter[J]. Gastroenterol Endosc, 2017, 59(5): 1289-1301.
[11]	刘国梁，徐静，余盈娟. 内镜黏膜下剥离术治疗胃固有肌层肿瘤的临床探讨[J]. 实用临床医药杂志, 2016, 20(3): 103-104.
[12]	仲恒高，缪林，季国忠，等. 内镜黏膜下剥离术治疗早期胃癌及癌前病变36例临床分析[J]. 中国内镜杂志, 2016, 22(1): 90-92.
[13]	袁媛，周炳喜，程黎娜，等. 内镜下黏膜下剥离术治疗69例食管早癌及癌前病变的价值及术后病理分析[J]. 中国内镜杂志, 2016, 22(8): 90-93.
[14]	凌鑫，朱虹，陈天宝，等. 单钳道内镜下金属夹联合尼龙绳的荷包缝合术[J]. 中华消化内镜杂志, 2015, 32(11): 764-766.
[15]	李歆，肖勇，吴楠楠，等. 预荷包缝合技术在腔外生长型胃黏膜下肿瘤内镜治疗中的应用[J]. 中华消化内镜杂志, 2017, 34(8): 586-589.
[16]	陆飞，沈美琴，张圣来. 内镜黏膜下剥离术治疗胃间质瘤的临床效果分析[J]. 国际消化病杂志, 2017, 37(4): 255-258.

组别	例数	性别(例)		年龄(岁)^a	手术史(例)		病灶位置(例)					病灶直径(cm)^a
组别	例数	男	女	年龄(岁)^a	有	无	胃窦后壁	胃窦大弯侧	胃体前壁	胃底	胃体大弯侧	病灶直径(cm)^a
观察组	39	26	13	41.2±9.5	10	29	2	8	2	13	14	1.7±0.8
对照组	33	23	10	40.6±9.8	8	25	1	7	1	11	13	1.6±1.0
统计值	?	0.225		0.635	0.277		0.273					0.752
P值	?	0.635		0.326	0.599		0.991					0.242

组别	例数	性别(例)		年龄(岁)^a	手术史(例)		病灶位置(例)					病灶直径(cm)^a
组别	例数	男	女	年龄(岁)^a	有	无	胃窦后壁	胃窦大弯侧	胃体前壁	胃底	胃体大弯侧	病灶直径(cm)^a
观察组	39	26	13	41.2±9.5	10	29	2	8	2	13	14	1.7±0.8
对照组	33	23	10	40.6±9.8	8	25	1	7	1	11	13	1.6±1.0
统计值	?	0.225		0.635	0.277		0.273					0.752
P值	?	0.635		0.326	0.599		0.991					0.242

组别	例数	手术时间(h)	留置胃管时间(d)	住院时间(d)
观察组	39	3.7±0.8	1.8±0.6	7.5±1.2
对照组	33	5.1±0.9	1.7±0.8	7.1±1.3
t值	?	4.159	0.605	0.416
P值	?	0.038	0.524	0.702

组别	例数	手术时间(h)	留置胃管时间(d)	住院时间(d)
观察组	39	3.7±0.8	1.8±0.6	7.5±1.2
对照组	33	5.1±0.9	1.7±0.8	7.1±1.3
t值	?	4.159	0.605	0.416
P值	?	0.038	0.524	0.702

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