胃间质瘤不同侵袭危险性的超声内镜图像特点

Evaluate the aggressive risk of gastric stromal tumors by findings with endoscopic ultrasonography

目的通过分析不同侵袭危险性的胃间质瘤的EUS图像特点，探讨EUS在胃间质瘤诊治中的价值。方法回顾性分析1997年7月至2007年7月北京大学第一医院普通外科收治的36例胃间质瘤患者临床资料，36例均经手术治疗，并且术前均行EUS。对所有病例进行Flecther侵袭危险性分级，记录内镜及EUS图像特点，包括肿瘤大小、有无溃疡、边界、内部回声是否均匀、内部回声特点及生长方式。对各侵袭危险性间质瘤的内镜及EUS图像特点进行归纳，差异比较采用方差分析及秩和检验。结果胃间质瘤的最大径平均7．3cm（1．0～20．0cm），侵袭危险性较高组肿瘤大于侵袭危险性较低组，差异具有统计学意义（P〈0．01）；侵袭危险性越高的胃间质瘤其溃疡、边界不清、外形不规则、内部回声不均匀现象越常见，组间差异有统计学意义（P〈0．05）。各组间肿瘤内部回声是否有囊性变或伴有点片状高回声以及肿瘤的生长方式，差异无统计学意义。结论根据EUS的图像特点，可以帮助术前判断胃间质瘤的侵袭危险性分级，对进一步诊治有重要意义。

Objective To analyze the characteristics of gastric stromal tumors （GST） under endoscopic uttrasonography （EUS） according to its aggressive risks. Methods The clinical data of 36 patients with GST, who underwent surgery from July 1997 to July 2007, were analyzed retrospectively. All the patients underwent EUS before operation and were classified according to Flectherg 4-tier system to predict the aggressiveness of the tumors. The features of the tumor under EUS including its size, ulceration, border, echo charateristics and growth pattern were recorded and the difference between each tumor group were ana- lyzed by ANOVO and rank sum test. Results The mean maximal diameter of GST was 7.3 cm （ range 1.0 -20. 0 cm）, and the size of tumors with higher aggressiveness risk was significantly larger than that with lower risk （ P 〈 0. 01 ）. The mueosal uleeration, obscure border, irregular shape and echo heterogeneity were more commonly seen in the groups with higher risk （ P 〈 0. 05 ）. There was no difference in the internal echo and growth pattern of GST between different groups. Conclusion EUS features are useful in differentiation of the aggressiveness risk of the GST, and guide the management of the tumors.