不同侵袭危险性胃间质瘤的超声内镜图像特点比较及相关危险因素分析

Comparison of endoscopic ultrasonography image characteristics and analysis of risk factors for different invasive risk of gastric stromal tumors

目的寻找不同侵袭危险性胃间质瘤（GSTs）的超声内镜（EUS）图像特点差异。方法收集温州市3大医院286例经病理及免疫组化确诊为GSTs患者,根据肿瘤大小、核分裂象将其分为极低危组、低危组、中危组以及高危组;回顾分析不同侵袭危险性GSTs组间临床资料及EUS图像特征,寻找差异并进行相关危险因素分析。结果 286例GSTs形状绝大多数规则（262/286）,最常起源于胃固有肌层（219/286）,病灶多呈低回声改变（254/286）、回声均匀（212/286）、边界清楚（264/286）,有一部分可见钙化（79/286）、溃疡（75/286）以及囊性变（54/286）。286例GSTs中极低危组60例（20.98%）,低危组112例（39.16%）,中危组73例（25.52%）,高危组41例（14.34%）;单因素分析显示侵袭危险性越高,溃疡越好发,内部回声不均匀、钙化及囊性变现象越常见;而进一步多因素分析显示溃疡的发生（OR=2.44,95%CI：1.36~3.18）是唯一预测GSTs侵袭危险性分级的独立因素（P〈0.05）。结论不同侵袭危险性GSTs在EUS图像的表现有所差异,除肿瘤大小、核分裂象外,表面溃疡的发生同样是预测GSTs侵袭危险性的重要标志。

Objective To find out different endoscopic ultrasonography image characteristics of different invasive risk of gastric stromal tumors. Method The data of 286 patients of gastric stromal tumors that diagnosed by pathology and immunohistochemistry from three hospitals in Wenzhou were investigated retrospectively. Gastric stromal tumors were divided into very low risk group, low risk group, intermediate risk group and high risk group according to tumor size and mitosis, compared of clinical data and endoscopic ultrasonography image characteristics for different invasive risk of gastric stromal tumors, looked for differences and analyzed related risk factors. Results About 286 patients of gastric stromal tumor, most of them have regular shapes（262/286）, originating from stomach muscularis propria（219/286）, and the lesions always showed up hypoechoic（254/286）, homogeneous echo（212/286）, clear border（264/286）; partial of calcification（79/286）, ulcers（75/286） as well as cystic degeneration（54/286）. And 60 patients were divided into very low risk group（20.98 %）, 112 patients of low risk group（39.16 %）, 73 patients of intermediate risk group（25.52 %）, 41 patients of high risk group（14.34 %）. Univariate analysis showed the performances of ulcer, heterogeneous echoes, calcification and cystic degeneration were more common in higher invasive risk groups; then multivariate analysis showed ulcer（OR = 2.44, 95%CI： 1.36 ~ 3.18） was the unique independent risk factor to predicting invasive risk of gastric stromal tumors（P〈0.05）. Conclusion The performance of ultrasound endoscopic image for different invasive risk of gastric stromal tumors was different; despite of tumor size and mitosis,ulcer was also prognostic significance of invasive risk of gastric stromal tumors.