经胃镜治疗胃黏膜下肿瘤61例临床分析

Clinical analysis of endoscopic treatment for patients with gastric submucosal tumors(61 cases)

目的分析胃黏膜下肿瘤的临床病理学特征,评价经内镜治疗胃黏膜下肿瘤的安全性及有效性。方法通过胃镜及超声内镜筛选出2012年9月-2014年6月共61例患有胃黏膜下肿瘤的患者;均采用经胃镜治疗方案予以切除;切除肿瘤术后均送病理学检查,可疑胃间质瘤进一步行免疫组化等分子生物学检查。结果 61例患者中,有39例为女性患者,占总病例63.93%,肿瘤位于胃底占52.46%(32/61),胃体21.31%(13/61),胃窦11.48%(7/61),贲门14.75%(9/61);10例行内镜黏膜剥离术(ESD),21例行内镜黏膜下挖除术(ESE),27例行内镜全层切除术治疗(EFR),3例经黏膜下隧道肿瘤切除术治疗(STER)。61例患者中,1例因瘤体过大且突破浆膜层,另1例位于胃底黏液湖操作困难故中转腹腔镜治疗,术后1例发生穿孔,经腹腔镜成功修补,1例发生出血,内镜下成功止血;病理学检查最后确诊胃间质瘤34例,危险度均为极低危(肿瘤每50个高倍镜视野下核分裂像≤5),平滑肌瘤11例、脂肪瘤5例、异位胰腺3例、钙化性纤维假瘤5例、炎性纤维性息肉2例和血管瘤样增生1例;胃间质瘤位于胃底73.53%(25/34),胃体11.76%(4/34),胃窦5.88%(2/34),贲门8.82%(3/34)。结论胃黏膜下肿瘤以女性多发,且多无特异性临床症状;胃黏膜下肿瘤好发于胃底,且以胃间质瘤多见;绝大部胃间质瘤风险分级为极低危;经胃镜治疗胃黏膜下肿瘤是微创、安全、有效的方法。

Objectives To analyze the clinical and pathological characteristics of gastric submucosal tumors（GSMTs）, and evaluate the safety and efficacy of endoscopic treatment for GSMTs. Methods 61 patients with GSMTs were selected from June 2014 to September 2012 by endoscopy and ultrasonography; they were all treated by endoscopic therapy; pathological examination was took in all removed tumors, the tumors which could be the gastric stromal tumor were furtherly examined by molecular biology technique of immunohistochemistry. Result In 61 cases, 39 cases are female patients, accounting for 63.93 %; the tumors located at the stomach fund accounted for 52.46%（32/61）, at the gastric corpus for 21.31 %（13/61）, at the gastric antrum for 11.48 %（7/61）, at cardia for 14.75 %（9/61）; 10 cases were treated by Endoscopic submucosal dissection, 21 by endoscopic submucosal excavation, 27 by Endoscopic full-thickness resection, 3 by Submucosal tunnelling endoscopic resection; in all 61 cases, 2 were changed to laparoscopic treatment because one tumor was too big and broke the Serous and another was located at mucus Lake of gastric fund, 1 occurred postoperative bleeding and was treated by laparoscopy successfully, 1 occurred postoperative perforation and was treated by endoscopy successfully; after pathological and immunohistochemical analysis, 34 tumors were identified as gastric stromal tumor and all of them in risk classification were atvery low risk, 11 were leiomyoma, 5 were lipoma, 3 were heterotopic pancreas, 5 were calcifying fibrous pseudotumor, 2 were inflammatory fibroid polyps, and 1 was angiomatous proliferation; gastric stromal tumor at gastric fundus account for 73.53 %（25/34）, at gastric corpus for 11.76 %（4/34）, at gastric antrum for 5.88 %（2/34） and at cardia for 8.82 %（3/34）. Conclusion Most GSMTs are found in female and commonly lack of specific clinical symptoms;GMSTs are commonly located at gastric fund and most of them are gastric stromal tumors, vast majority of gastric stromal tumors in the risk classification are at very low risk; the endoscopic resection is a mini-invasive, safe and effective treatment for GSMTs.