小探头超声内镜联合CT检查对较大胃黏膜下肿瘤治疗方案选择的价值

Role of miniprobe endoscopic ultrasonography combined with CT scanning in diagnosis and treatment of large gastric submucosal tumors

目的评价小探头超声内镜联合CT检查对较大胃黏膜下肿瘤诊疗中的作用,以此指导临床治疗方案的选择。方法小探头超声内镜发现胃黏膜下肿瘤52例,超声剖面直径≥20mm,结合腹部64排螺旋CT检查,判断肿瘤的位置、来源、周围及远处器官转移等情况,对腔内生长未累及浆膜的肿瘤行ESD治疗,对侵及浆膜和向腔外生长的行腹腔镜或剖腹手术治疗,所有切除标本送常规病理检查及免疫组化检测,半年后对患者进行胃镜及CT随访。结合疗效来评价小探头超声内镜联合CT检查在较大胃黏膜下肿瘤治疗过程中的作用。结果良性间质瘤20例,恶性间质瘤16例,平滑肌瘤5例,异位胰腺6例,脂肪瘤5例,CT提示30例腔内生长,未侵犯浆膜,无周围器官转移,予内镜下ESD治疗,仅有2例穿孔,经钛夹夹闭和保守治疗好转。其余22例CT检查为腔内及腔外生长予外科手术或腹腔镜治疗。术后3个月复查,所有病变愈合好,无复发。结论小探头超声内镜联合CT对较大胃黏膜下肿瘤进行检查,可获得较准确的病变情况,对胃黏膜下较大的肿瘤治疗方案的选择具有重要的指导意义。

Objective To evaluate the role of miniprobe endoscopic ultrasonography combined with CT examination in diagnosis and treatment of large gastric submucosal tumors（SMT）.Methods Fifty-two cases of SMT with ultrasound cross-section diameter not less than 20 mm detected by miniprobe endoscopic ultrasonography combined with abdominal 64-slice CT examination were collected to determine the location of tumor invasion,depth,origin and surrounding and distant organ metastasis.The gastric submucosal tumors growing in gastric lumen without involving gastric serosa were treated with endoscopic submucosal dissection（ESD）.The tumors invading gastric serosa and growing to the outside of gastric lumen were treated with laparoscopy or laparotomy.All the resected specimens were sent to routine pathological examination and immunohistochemistry.All the patients were followed up by gastroscopy and CT after six months.The role of miniprobe endoscopic ultrasonography combined with CT examination in the diagnosis and treatment of large gastric SMT was evaluated based on the efficacy.Results There were 20 cases of benign stromal tumor,16 cases of malignant stromal tumor,5 cases of leiomyoma,6 cases of ectopic pancreas and 5 cases of lipoma.CT examination showed 30 cases of gastric submucosal tumors growing in gastric lumen without gastric serosa involvement and surrounding organ metastasis,which were treated with ESD.In the 30 cases,2 cases of gastric perforation were observed and were treated by titanium clipping and conservative treatment.The remaining 22 cases were treated with laparoscopy or laparotomy.After 3 months,all the lesions healed without recurrence.Conclusion Miniprobe endoscopic ultrasonography combined with CT examination in diagnosis of large gastric SMT can obtain accurate pathological condition,which is important for selecting therapeutic regimens for large gastric SMT.