上消化道不同部位黏膜下肿瘤的临床病理学特征

Clinicopathological features of submucosal tumors in different upper gastrointestinal locations

目的探讨不同部位上消化道黏膜下肿瘤（SMTs）的临床病理学特征。方法2008年1月至2012年12月，在复旦大学附属中山医院内镜中心行胃镜下诊疗，经病理确诊为上消化道SMTs，且资料记录完整的1743例患者（1775例次诊疗）纳入回顾性研究，分析上消化道各部位SMTs的临床病理学特征。结果（1）食管SMTs702例次，其中平滑肌瘤占92．59％（650／702）。（2）胃SMTs1045例次：胃底405例次，其中胃肠间质瘤占61．48％（249／405）、平滑肌瘤占35．56％（144／405）；胃体307例次，其中胃肠间质瘤占46．58％（143／307）、平滑肌瘤占29．32％（90／307）；胃窦191例次，其中异位胰腺占43．46％（83／191）、错构瘤占23．56％（45／191）、脂肪瘤占14．66％（28／191）、胃肠间质瘤占10．47％（20／191）；贲门142例次，其中平滑肌瘤占77．46％（110／142）。（3）十二指肠SMTs28例次：球部19例次，其中异位胰腺10例次、Brunner瘤4例次、胃肠间质瘤3例次；降部9例次，其中脂肪瘤4例次、异位胰腺2例次、胃肠间质瘤1例次、其他2例次。结论食管内多为平滑肌瘤。胃底及胃体部多见胃肠间质瘤及平滑肌瘤，胃窦部多见异位胰腺及错构瘤，贲门部多见平滑肌瘤。十二指肠球部多见异位胰腺、Brunner瘤及胃肠间质瘤，降部则多见脂肪瘤。

Objective To analyze the clinicopathological characteristics of upper gastrointestinal submucosal tumors （SMTs）. Methods Clinicopathological data of 1 743 patients with 1 775 upper gastrointestinal SMTs in our department from January 2008 to December 2012 were retrospectively analyzed. Results The first finding was that in 702 esophagus cases, leiomyoma （ 92. 59%, 650/702） was the most common type of esophageal SMTs. Second, in 1 045 gastric eases, there were 405 lesions at gastric fundus, the most common type of SMTs were 249 （ 61.48% ） GISTs and 144 （35.56%） leiomyoma. In 307 lesions located at body,the most common type of SMTs were 143（46. 58%） GISTs and 90（ 29. 32%） leiomyoma. In 191 lesions located at antrum, the most common type of SMTs were 83 （43.46%） heterotopia pancreas and 45 （23.56%） hamartoma, followed by 28 （ 14. 66% ） lipoma and 20 （ 10. 47% ） GISTs. In 142 lesions located at eardia, the most common type of SMTs was 110（77. 46%） leiomyoma. Third, in 28 duodenum cases, there were 19 lesions at duodenal bulb, the most common type of SMTs was 10 heterotopia pancreas, 4 Brunner gland adenoma and 3 GISTs. In 9 lesions located at descending duodenum, the most common type of SMTs was 4 lipomyoma, followed by 2 eetopic pancreas, 1 GISTs and 2 others. Conclusion Leiomyoma is the most common type of esophageal SMTs.In gastric fundus and body, the most common type of SMTs are GISTs and leiomyoma. In antrum, the most common type of SMTs are heterotopia pancreas and hamartoma, but in cardia, that is leiomyoma.In duodenal bulb, the most common type of SMTs are heterotopia pancreas, Brunner gland adenoma and GISTs, and in descending duodenum, is lipomyoma.