双气囊内镜对小肠间质瘤诊治方式变迁的影响

The impact of double-balloon enteroscopy on the evolution of detection and surgical treatment for small bowel stromal tumors

目的总结9年来诊治小肠间质瘤的经验，探讨双气囊内镜（DBE）在诊治方式变化中的作用。方法回顾性分析193例局灶性小肠间质瘤患者，将其分为小肠CT造影（CTE）和（或）DBE组（n=100）以及其他传统方法组（n=93）。然后再分成开腹手术组（n=126）和腹腔镜辅助组（n=67）。按照检查和手术方式的发展，比较DBE引进前后的变化。结果CTE和（或）DBE组患者的平均年龄和肿瘤直径都显著小于传统方法组[年龄（50．9±12．1）与（56．9±11．6）岁，肿瘤直径（3．6±1．3）与（6．1±2．6）cm，P〈0．01]。未引进DBE前，2001年1月至2002年12月，均为传统检查方式，开腹手术平均4例／年。引进DBE后，2003年1月至2004年12月，84．6％（11／13）的患者由DBE检出。2005年1月至2008年12月，50．0％（23／46）的患者由CTE和DBE联合检出。2009年1月至2011年12月，80．5％（33／41）的患者由CTE检出，手术例数已递增至25例／年，较未引进前增加约5．3倍。行腹腔镜辅助切除的患者中，82．1％（55／67）由CTE和（或）DBE检出，中、低危占89．1％（49／55）。结论DBE对于小肠间质瘤诊治方式的优化具有积极的推动作用。

Objective To investigate the role of double-balloon enteroscopy （DBE） in the evolution of detection and surgical treatment of small bowel stromal tumors （ SBSTs）, based on nine years experience. Methods In this retrospective study, 193 patients with localized SBSTs were divided into the CT-enterogra- pby （CTE） and/or DBE group （n = 100） and conventional modalities group （n =93）. These patients were further divided into the open surgery group （ n = 126 ） and laparoscopy-assisted resection group （ n = 67 ）. The development of clinical diagnosis and surgical treatment strategies were compared before and after the in- troduction of DBE. Results The average age and tumor size were significantly smaller in the CTE and/or DBE group than those in the conventional modalities group, respectively （ age： 50. 9 ± 12. 1 vs. 56.9 ±11.6 years ; tumor size ： 3.6 ±1.3 vs. 6. 1 ＋ 2. 6 cm, P 〈 0.01 ）. Before the introduction of DBE （ from January 2001 to December 2002 ）, all patients underwent conventional modalities, and only 4 cases/year for open surgery. Afterward, from January 2003 to December 2004, 84. 6% （11/13） of SBSTs were detected by DBE. From January 2005 to December 2008, 50. 0% （23/46） of SBSTs were found by CTE combination with DBE. From January 2009 to December 2011, 80. 5% （33/41） of SBSTs were diagnosed by CTE, and the number of patients underwent operation increased up to 25 cases/year, which was nearly 5.3 folds higher than that before the introduction of DBE. Sixty-seven patients were successfully operated by laparoscopy-as- sisted resection, 82. 1% （55/67） of them were detected by CTE and/or DBE, 89. 1% （49/55） of whom had low- or intermediate-risk SBSTs. Conclusion DBE plays an important role in optimizing the algorithm of detection and treatment of SBSTs.