胃粘膜下肿物的临床特征和内镜治疗效果评价

Clinical features of gastric submucosal tumors and evaluation of endoscopic therapeutic effects

目的:探讨胃粘膜下肿物(SMT)的临床特点,评价内镜下治疗的效果和安全性。方法:回顾性分析2008年6月-2018年6月在天津医科大学总医院内镜中心接受内镜下治疗的1062例胃SMT患者的临床特征、内镜治疗和随访情况。结果:1144例次肿物平均直径(1.2±0.8)cm,61.7%位于贲门胃底部,71.7%起源于固有肌层。胃肠间质瘤(GIST,37.3%)和平滑肌瘤(33.0%)最多,前者多见于胃底穹隆而后者更常见于胃食管结合部附近(P<0.001)。内镜治疗胃SMT完全切除率92.8%,非完全切除与肿物直径>2 cm(P<0.001)、肿物形状不规则(P<0.05)及肿物边界不清(P<0.01)相关。治疗后随访6~113个月,均未见肿瘤复发和转移。结论:不同类型SMT在胃的分布、起源不同;内镜下治疗胃SMT安全、有效,可成为极低/低危险度GIST的主要治疗手段之一。

Objective:To investigate the clinical features of gastric SMTs and evaluate the efficacy and safety of endoscopic therapy.Methods:We retrospectively analyzed the clinical characteristics,therapeutic outcomes and follow-up consequences of 1062 patients with gastric SMTs undergoing endoscopic therapies between June 2008 and June 2018 in Tianjin Medical University General Hospital.Results:Totally,1144 SMTs with average diameter of(1.2±0.8)cm were included.SMTs mainly occurred in the cardiac fundus(61.7%)and mostly originated from the muscularis propria(71.7%).Gastrointestinal stromal tumor(37.3%)and leiomyoma(33.0%)were the most,and the former appeared mostly in the fundus while the latter occurred adjacent to the esophagogastric junction(EGJ)(P<0.001).The rate of complete resection was 92.8%while non-complete resection was associated with tumor size>2 cm(P<0.001),irregular shape(P<0.05)and distinct border of the lesion(P<0.01).No recurrence or metastasis was found during the follow-up of 6~113 months.Conclusion:The gastric SMT with different histopathological type differed in their intragastric distribution and layer of the origin.Endoscopic therapy was safe and effective for gastric SMTs,which could be regarded as one of the main methods treating GIST with low or very low risk.