背景:胃肠道神经鞘瘤最常见于胃中。由于它们的非特异性临床和内窥镜表现,根据典型症状和内镜特征将胃神经鞘瘤(GS)与其他胃粘膜下肿瘤区分开来具有挑战性。内镜全层切除术(EFTR)对于GS管理是安全有效的;然而,在内镜治疗后,没有标准的方法提取大的胃标本。
方法:我们报告一例72岁的中国女性腹胀。
方法:胃镜检查显示,下胃前壁靠近大曲率处的粘膜下隆起。超声内镜和计算机断层扫描提示间质瘤。病人接受了胃的EFTR,肿瘤被成功切除.手术标本,体外长轴直径约为5.5厘米,是用圈套提取的。随后的内窥镜检查显示纵向,全厚度穿孔>2厘米在食管入口处。超过10个金属夹子被用来密封粘膜,放置胃肠减压管。术后1周进行的随访X线检查显示食管纵隔瘘,这需要随后的内窥镜介入以使用金属夹关闭瘘管。患者症状好转,术后3周出院。随访食管造影未见异常。术后免疫组化提示CD34(-),CD117(-),DOG-1(-),Ki67(1%),S-100(+),SDHB(+),SOX-10(+),和Desmin(-),确认GS的诊断。术后三个月,胃镜检查显示食管穿孔愈合良好,局部形成了白色的溃疡疤痕,在胃体中发现了金属夹,没有发现复发。
结论:EFTR对去除巨大神经鞘瘤有效,尽管提取大标本可能会导致医源性颈食管穿孔。>2厘米的穿孔可以使用内窥镜金属夹闭合来管理。
BACKGROUND: Gastrointestinal schwannomas are most commonly found in the stomach. Owing to their nonspecific clinical and endoscopic presentations, distinguishing gastric schwannomas (GS) from other gastric submucosal tumors based on typical symptoms and endoscopic features is challenging. Endoscopic full-thickness resection (EFTR) is safe and effective for GS management; however, no standard method exists for the extraction of large gastric specimens after endoscopic treatment.
METHODS: We report the case of a 72-year-old Chinese woman who presented with abdominal distension.
METHODS: Gastroscopy revealed a submucosal bulge on the anterior wall of the lower stomach near the greater curvature. Endoscopic ultrasonography and computed tomography suggested a stromal tumor. The patient underwent EFTR of the stomach, and the tumor was successfully removed. The surgical specimen, with a long-axis diameter of approximately 5.5 cm in vitro, was extracted using a snare. Subsequent endoscopic examination revealed longitudinal, full-thickness perforations > 2 cm at the esophageal entrance. Over 10 metal clips were used to seal the mucosa, and a gastrointestinal decompression tube was placed. Follow-up radiography performed at 1 week postoperatively revealed an esophageal mediastinal fistula, which required subsequent endoscopic intervention to close the fistula using metal clips. The patient showed improvement and was discharged at 3 weeks postoperatively. Follow-up esophageal radiography revealed no abnormalities. Postoperative immunohistochemical analysis indicated CD34 (-), CD117 (-), DOG-1 (-), Ki67 (1%), S-100 (+), SDHB (+), SOX-10 (+), and Desmin (-), confirming the diagnosis of GS. Three months postoperatively, gastroscopy showed that the esophageal perforation healed well, a white ulcer scar had formed locally, metal clips were found in the stomach body, and no recurrence was found.
CONCLUSIONS: EFTR is effective for removing giant schwannomas, although the extraction of large specimens may result in iatrogenic cervical esophageal perforations. Perforations > 2 cm can be managed using endoscopic metal clip closure.