内镜黏膜下挖除术治疗胃胃肠间质瘤的疗效分析

Efficacy analysis of endoscopic submucosal excavation for gastric gastrointestinal stromal tumors

目的探讨内镜黏膜下挖除术（ESE）治疗胃胃肠间质瘤（GIST）的安全性和有效性。方法回顾性分析2007年1月至2013年1月间在武汉大学人民医院接受ESE治疗的86例胃GIST患者的临床资料，术后做全瘤活检以明确GIST危险度，记录ESE手术并发症，并通过随访追踪术后复发情况。结果86例肿瘤均完整切除，术后病理未见肿瘤残留；按照美国国立卫生署（NIH）的分级标准，极低度危险者12例，低度危险者30例，中度危险者25例，高度危险者19例。肿瘤越大、起源越深及存在表面水肿或出血者，危险度越高（均P〈0．05）。ESE手术出血率为5．8％（5／86），其中术中大出血1例，术后延迟性出血4例；其中3例为中度危险者，2例为高度危险者。穿孔率为10．5％（9／86），其中5例为中度危险者，4例为高度危险者。术后复发率为5．8％（5／86），其中4例为中度危险者，1例为高度危险者。结论ESE治疗胃GIST安全而有效：是否出现手术并发症及术后复发可能主要取决于肿瘤的危险度分级。

Objective To assess the efficacy and safety of endoscopic submucosal excavation （ESE） for gastric gastrointestinal stmmal tumors （GISTs）. Methods Clinical data of 86 gastric GISTs patients undergoing ESE in our department from January 2007 to January 2013 were analyzed retrospectively. The whole tumor biopsy was used to determine the risk stratification. Complication of ESE was recorded and recurrence was investigated during regular follow-up. Results Tumors of all 86 cases were resected completely without residue proved by postoperative pathology. According to NIH risk stratification, 12 cases were very low risk, 30 low risk, 25 moderate risk, and 19 high risk. Tumor size, tumor depth, and tumor surface bleeding or edema were associated with the risk stratification of the GISTs（all P〈0.05）. Bleeding rate of ESE was 5.8%（5/86）, including severe intraoperative bleeding in 1 case, postoperative delayed bleeding in 4 cases. The maximal tumor diameter was 〈 2 cm in 1 case and 〉 2 cm in 4 cases. The tumor were grade as moderate risk in 3 cases and high risk in 2 cases. The perforation rate was 10.5% （9/86）, including tumors with a maximal diameter of 〈 2 cm in 4 cases and 〉 2 cm in 5 cases. The tumors were grade as moderate risk in 5 cases and high risk in 4 cases. Recurrence rate was 5.8% （5/86）, including tumors with a maximal diameter 〈 2 cm in 2 case and 〉2 cm in 3 cases. The tumors were grade as moderate risk in 4 cases and high risk in 1 cases. Conclusion ESE is safe and effective for the treatment of gastric GISTs. The operative complication and postoperative recurrence may be associated with the tumor risk stratification.