The Study And Clinical Application Of Endoscopic Resection Of Stromal Tumors Of The Stomach

Objective: To investigate the efficacy and safety of endoscopic resection of gastric stromal tumors.Methods: This study is based on 30 cases of gastric muscularis propria stromal tumors showed by endoscopic ultrasonography and abdominal CT examination following ordinary gastroscopy in Yantai Yuhuangding Hospital affiliated to Qingdao University from Semptember 2015 to December 2016.All patients received anesthesia endoscopic resection in tracheal intubation plus compound intravenous anesthesia,including ESE(Endoscopic Submucosal Enucleation)or EFR(Endoscopic Full-thickness Resection),and postoperate follow-ups to evaluate the efficacy and safety.A total of 30 cases of patients who meet the following requirements: 1 EUS showed lesions from gastric muscularis propria,showed low echo;the maximum diameter of the tumor 3.5cm;the tumor capsule integrity and clear boundary,internal echo uniform;the intraluminal tumor;the CT and enhanced CT found no lymph node metastasis and other organs that malignant tendency.Of these,17 were male and 13 were female,with an average age of 59.6 years(28-78 years).All the patients were given detailed examination of the operation risk before the operation,and the related informed consent was signed,and the benefits and risks of the operation were explained.Patients should be forbidden to take aspirin and other drugs a week before the operation,and routine examination of blood routine and routine ECG should be performed before the operation.In addition,the patient should be fasted for 8-10 hours.All patients received routine fasting and bed rest for 1-2 days.During the period,they were given total parenteral nutrition,proton pump inhibitors,acid suppression,and conventional antibiotic therapy.All the patients treated with ESE and EFR were treated with formalin and the pathological examination was performed immediately after surgery.We should closely observe the patient’s condition changes,observe whether gastrointestinal bleeding were postoperative,no chest tightness,shortness of breath,cyanosis,abdominal pain,abdominal distension and signs of peritonitis,no subcutaneous emphysema can be given gastrointestinal decompression,check the chest X-ray,an abdominal X-ray when necessary.2-3 days after surgery,no special discomfort,such as bleeding and abdominal pain,can be given liquid diet,3-4 days after surgery,according toThe situation can be given semi liquid diet.The court review of 1,3,6 electronic gastroscope,12 months after surgery,observed after stripping wound healing,metal clip off,if necessary,ultrasonic gastroscopy lesion recurrence,CT and enhanced CT metastasis situation.Generally given 6-8 weeks proton pump inhibitors,ulcers healed basically.Results: In the 30 cases,stromal tumors originated from the muscularis propria of the stomach were successfully removed,including 22 cases of ESE resection and 8 cases of EFR resection;Successful clippings with metal titanic clips were performed in all the 8 EFR resections;Postoperative pathological diagnosis: stromal tumors,including 8 of gastric body,18 of stomach fundus and 4 of gastirc antrum;Maximum diameters of lesion range from 0.5-3.5cm(2.2 on average);the length of surgery time of endoscopic excision is 30-180 mins(73.3 mins on average);in all 30 cases,small amount of bleeding was found during operation and no severe complications were found after surgery.Conclusion: Endoscopic resection is a safe and effecitve treatment for gastric muscularis propria lelomyoma with small trauma,high total excision rate and good clinical value.