食管间质瘤与胃间质瘤的临床特点及内镜治疗

Clinical characteristics and treatment of esophageal stromal tumors and gastric stromal tumors under endoscope

目的：探讨食管间质瘤和胃间质瘤的临床特点及内镜下治疗。方法回顾性分析经本院内镜治疗的30例食管间质瘤和146例胃间质瘤的临床资料。分析患者的基本情况、病变部位及起源、免疫组织化学特征、治疗情况以及术后随访结果。结果食管间质瘤30例,男22例,女8例。病变多位于食管下段,63.3%病变起源于固有肌层。胃间质瘤146例,男41例,女105例。病变多位于胃底部,98.0%病变起源于固有肌层。免疫组织化学检查示食管间质瘤 CD117,CD34,SMA,desmin 阳性率分别为93.3%,93.3%,73.3%,73.3%；胃间质瘤 CD117,CD34,SMA,desmin阳性率分别为94.5%,88.4%,21.9%,19.2%。22例食管间质瘤行内镜黏膜下剥离术（ESD）,8例行内镜黏膜下隧道肿瘤切除术（STER）,病灶均一次性完整切除,1例患者 ESD 术中发生穿孔。145例胃间质瘤行 ESD,1例行内镜下氩离子凝固术（APC）,一次性完整切除率95.2%,术中穿孔39例,出血1例。所有穿孔及出血患者均经内镜下修复。术后随访3~50个月未发现肿瘤残留和复发。结论胃肠道间质瘤缺乏特异性临床表现,但食管间质瘤和胃间质瘤在肿瘤位置分布和起源、免疫组织化学方面各具特点,内镜下微创技术已发展为治疗胃肠道间质瘤新的手段之一。

Objective The study aimed to investigate the clinical characteristics and treatment of gastrointestinal stromal tumor between esophagus and stomach under endoscope.Methods A total of 30 patients with esophageal stromal tumors and 146 patients with gastric stromal tumors which experienced endoscopic surgery were enrolled.The demographic information,disease location and origination,immunohistochemistry features,treatment and follow-up outcome were analyzed.Results Among 30 patients with esophageal stromal tumors,22 were males and 8 were females.The lesions mainly located in the lower thirds of the esophagus and 63.3% of the lesions originated from the muscularis propria.Of 146 patients with gastric stromal tumors,41 were males and 105 were females.Most of the lesions located in fundus and 98.0% of the lesions arose from the muscularis propria.Positive rate of CD1 1 7,CD34, SMA and desmin in esophageal stromal tumors were 93.3%,93.3%,73.3% and 73.3%,respectively.Positive rate of CD1 1 7,CD34,SMA and desmin in gastric stromal tumors were 94.5%,88.4%,21.9% and 1 9.2%,respectively.22 patients and 8 patients with esophageal stromal tumors received endoscopic submucosal dissection （ESD ） and submucosal tunneling endoscopic resection（STER）,and all tumors were removed completely.Perforation occurred in one patient in procedure of ESD.145 patients and 1 patient with gastric stromal tumors underwent ESD and argon plasma coagulation （APC ）,respectively.The one-time complete resection rate was 95.2%.Perforation and intraoperative bleeding occurred in 39 patients and 1 patient,respectively.All patients with perforation and intraoperative bleeding were successfully repaired by endoscopic measures.Patients were followed up for 3 to 50 months,and no residue or recurrence of tumor was detected.Conclusion Gastrointestinal stromal tumor has no special clinical manifestation.However,esophageal stromal tumor and gastric stromal tumor have their own feature in tumor location, origination and immunohistochemical features.Minimally invasive surgery under endoscope proved to be a new choice for treating gastrointestinal stromal tumor.