| PartⅠ: Analysis of the epidemiological characteristics of 819 cases ofupper gastrointestinal submucosal lesionsObjective: To understand the epidemiological characteristics of upper gastrointestinal submucosal lesions in Qinghai area.Methods: The general biological characteristics of submucosal lesions,which had been detected by endoscopic ultrasonography in Qinghai People’s Hospital in recent 5 years, were retrospective analysis.Results: A total of 1926 cases of endoscopic ultrasonography had been detceted, 819 cases of submucosal lesions were detected, Submucosal lesions accounted for 42.5% of the number of cases of endoscopic ultrasonography; Male and female were 424 and 395 cases respectively. The esophageal, gastric and duodenal submucosal lesions were 321, 395 and 103 cases, respectively. SMT 506 cases, non SMT 313 cases, the ratio of two to 1.617:1. There were 320 cases of stromal tumors had been detected, the ratio of male to female was 1:1.19, the age of onset 15-82 years; gastric stromal tumors account for 62.8% of the upper gastrointestinal stromal tumors, the stomach is an organ that is easy to occur stromal tumors; gastric fundus and gastric body accounted for 71.1% of gastric stromal tumors, The fundus and body is the predilection site of gastric stromal tumors. there were 123 cases of leiomyoma had been Detected, male and female ratio of 1.16:1, the age of onset 15-82 years; the proportion of esophagus leiomyoma accounted for 77.24% of the upper gastrointestinal leiomyoma, the esophagus is an organ that is easy to occur leiomyoma, most of the esophageal leiomyoma originated in the mucosa and most of the stomach leiomyoma originated from the intrinsic muscle layer. There were 55 cases of lipoma had been dected, the ratio of male to female was 1.62:1, the age of onset 25-81 years; the proportion of gastric lipoma account for 63.64% of the upper gastrointestinal lipoma, the stomach is an organ that is easy to occur lipoma; the proportion of gastric antrum lipoma account for 80% of the gastric lipoma, 93.36% of the lipoma originated in the submucosal layer. There were 125 cases of ectopic pancreas had been detected, the ratio of male to female was 1:1.08, the age of onset 17-79 years; distributed in the stomach and duodenum, the proportion of gastric ectopic pancreas account for 86.4 of upper gastrointestinal ectopic pancreas, 63.9% of gastric ectopic pancreas occurs in the gastric antrum, ectopic pancreas all originated in the submucosal layer. There were 160 cases of cyst had been detected, the ratio of male to female was 1.5:1, the age of onset 23-84 years; the esophagus and duodenum are the place where the cyst is easy to occur, 98.1% of the cysts originated in the submucosal layer. Conclusion: The epidemic of gastric mucosal lesions in upper gastrointestinal in Qinghai area is not consistent with the report at home and abroad, This is help for endoscopic doctors to understand the pathological changes of gastric mucosal lesions in the region.PartⅡ: Effective and safety evaluation of endoscopic resection ofesophageal submucosal tumorsObjective: To evaluate the efficacy and safety of treatment of esophageal submucosal tumors by endoscopic in qinghai area.Methods: 38 cases of esophageal submucosal tumors were resected by EMR, ESE, STER, different surgical methods tumor resection rate, complication rate, hospitalization time, operation time, postoperative fasting time and hospitalization expenses were analyzed.Results: 38 cases of esophageal submucosal tumors were completely resected, the success rate was 100%, there were 13 cases of tumor resected by EMR, 20 cases of tumor resected by ESE and 5 cases of tumor resected by STER; EMR bleeding rate was 30.8%, ESE, STER bleeding rate was 100%, Bleeding can be treated by hot biopsy forceps electrocoagulation, Postoperative complications occurred in 7 cases, the complication rate was 18.4%, Including 1 cases of bleeding, 1 cases of perforation, 3 cases of subcutaneous and mediastinal emphysema, 2 cases infection; EMR operation time, average hospitalization cost was significantly lower than that of ESE and STER group, The occurrence of complications because of tumor size, After the occurrence of complications, the fasting time, hospitalization time, hospitalization costs were significantly higher than those without complications.Conclusion: endoscopic therapy esophageal submucosal tumors is safe and effective in the Qinghai area Part Ⅲ:Comparative study of resection gastric submucosal tumor by theway of ESE and EFRObjective: To evaluate the efficacy and safety of endoscopic treatment for gastric submucosal tumors.Methods: there were 57 gastric submucosal tumor patients treated by the resect way of ESE and EFR, the resection rate, incidence of complications, operation time, intraoperative blood loss, postoperative hospital stay and hospital costs were analyzed.Results: In addition to 1 cases of failure, the remaining 56 cases were successfully resected, the success rate was 98.2%, postoperative complications occurred in 6 cases, the complication rate was 10.7%. There were 44 patients were resected by ESE, complications occurred in 1 case, the complication rate was 2.3%, there were 12 patients were resected by EFR, complications occurred in 5 cases, the complication rate was 41.7%, the incidence of complications of EFR was significantly higher than that of ESE, and the incidence of complications was statistically different between the two types of resect way(P<0.05). The ESE average operation time was 45.2 minutes, EFR average operation time was 65.8 minutes, the two kinds of operation time had statistical difference(P<0.05); the ESE average intraoperative bleed loss 23.6ml, EFR average intraoperative bleed loss 56.1ml, two kinds of the average intraoperative blood loss difference was statistically significant(P<0.05); There was no difference between ESE and EFR in postoperative hospital stay and total hospital costs(P>0.05); there was an average 28 mm of tumor size in the complication group, which was significantly greater than that in the non complication group 12.58 mm, the difference was statistically significant(P<0.05); there was an average 66.7 minutes of operation time in the complication group, which was significantly longer than that in the non complication group 45.6 minutes, the difference was statistically significant(P<0.05); the average hospitalization expenses of the patients with complications were RMB 31940.8 yuan, expensiver than that of the non complication group of RMB 22510.8 yuan, the difference was statistically significant(P<0.05).Conclusion:It is safe and effective to resect gastric submucosal tumor by ESE, EFR is an effective way of resection, but it requires high technical requirements, because of its high incidence of complications, need to be carefully carried out. Part IV: Comparative study of resection gastric submucosal tumor by theway of EFR and LWRObjective: To evaluate the efficacy and safety of endoscopic full-thickness resection without assistance of laparoscopy(EFR) and Laparoscopic wedge resection(LWR) treatment for gastric submucosal tumors.Methods: there were 23 cases of gastric submucosal tumor patients included in study, 13 cases treated by the resect way of EFR and 10 cases treated by the resect way of LWR, the resection rate, incidence of complications, operation time, intraoperative blood loss, postoperative hospital stay and hospital costs were analyzed.Results: In addition to 1 case of failure, the remaining 12 cases were successfully resected by EFR, the success rate was 92.3%, postoperative complications occurred in 5 cases, the complication rate was 41.7%; all of 10 casess were resected by LWR, the success rate was 100%, postoperative complications occurred in 1 case, the complication rate was 10.0%. There were no statistically different between the two types of resect way(P>0.05). The LWR average postoperative hospital stay was 10.7 days, it was significantly longer than the EFR, which average postoperative hospital stay was 7.0 days, the two kinds of postoperative hospital stay had statistical difference(P<0.05); The LWR average total hospital costs was RMB 35891.0 yuans, it was significantly expensive than the EFR, which average total hospital costs was RMB 24970.7 yuans, the two kinds of total hospital costs had statistical difference(P<0.05); There was no difference between EFR and LWR in the success rate of the operation, Complication rate and intraoperative blood loss(P>0.05).Conclusion: LWF is safety and efficacy in the treatment of gastric submucosal tumors. although there are have same efficacy between EFR in LWR, but the safty of EFR low than LWR, therefore be cautious in clinical practice. |
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