老年患者消化道黏膜下肿瘤22年内镜随访

A retrospective study of 22 years endoscopic follow-up in elderly patients with gastrointestinalsubmucosal tumors

目的探讨老年患者中直径较小的消化道黏膜下肿瘤（SMT）的发生特点、动态变化规律及恶性风险。方法对1981年4月至2010年9月解放军总医院≥65岁经内镜诊断为SMT的老年患者进行回顾性分析研究。共54例，男51例（94．4％），女3例（5．6％），平均年龄为（74±1）岁。收集每次随访中患者的症状，SMT的数量、所在部位、形状、大小（以内镜或超声内镜下最大横径为标准）、黏膜是否光滑，随访次数，随访时长，相关治疗和手术后病理诊断结果等。观察SMT在老年患者中的发生特点及其动态变化规律，并根据SMT直径将患者分为直径≤1cm组（n=36）和〉1cm且≤3cm组（n=16），对比两组在内镜随访过程中的变化情况。结果54例患者中2例直接切除未进行随访，其余52例进行了22年的内镜随访，SMT中位直径0．9（0．3-3．0）cm。5例患者在随访14个月至6年时2例因肿瘤显著增长、2例因黏膜溃疡、1例黏膜溃疡同时伴有肿瘤的增大而切除，病理证实均为恶性。直径≤1cm组患者中仅有1例（2．8％）在随访至第6年时恶变，而〉1cm且≤3cm组有4例，且恶变的最短时间间隔为14个月。直径≤1cm组恶变率明显更低（P〈0．05）。结论在老年患者中直径较小的SMT（尤其≤1cm）发生率较高，但其恶变率低，因此，对于直径较小（≤3cm）且内镜或超声内镜下无明显恶变征象的老年SMT患者，可根据SMT大小制定合理的随访问隔并进行长期的内镜随访。

Objective To observe the occurrence characteristics, dynamic variations and potential risks of smaller gastrointestinal submucosal tumor （SMT） in elderly patients. Methods A total of 54 SMT patients were retrospectively recruited from January 1981 to September 2010. There were 51 males （94. 4% ） and 3 females（5.6% ） with an average age of（74 ± 1 ） years. During each visit, all the relevant data were collected, including symptoms, number of lesion, lesion location, shape, size （ maximum transverse diameter under endoscope or endoscopic ultrasonography （EUS）, morphology of mucosa, frequency and duration of follow-ups, treatment and pathological results. And the data were analyzed to examine the characteristics of SMT in elderly patients and their dynamic variations. Further more, according to lesion diameter, they were divided into two groups： a diameter ≤1 cm （n =36） and a diameter 〉 1 cm and ≤3 cm （n = 16 ）. Then the change of two groups were observed and compared during the follow- ups. Results Two cases were not under surveillance after direct surgical resection. The other 52 patients received a follow-up of 22 years. Among them, 5 patients underwent surgical resection for fast-growing tumor and mucosal ulcer. And all their pathologic diagnoses were malignant. Only 1 patient （2. 8% ） in the diameter ≤ 1 cm group and 4 in the diameter 〉 1 cm and ≤3 cm group turned malignant at 6 years. But, among 4 patients, the shortest interval was merely 14 months. Therefore, compared with the diameter 〉 1 cm group, the diameter ≤ 1 cm group had a lower rate of malignancy （ P 〈 0. 05 ）. Conclusions The incidence of smaller SMT （ especially diameter≤ 1 cm） is high in elderly patients, but the malignant potential remains low. Therefore, for elderly patients whose diameters of SMT are no bigger than 3 cm and without obvious malignancy under endoscope or EUS, we may plan an appropriate surveillance interval based on the size of tumor during a long follow-up period.