胃肠间质瘤的临床特征及其内镜下治疗的疗效研究

Clinical characteristics of gastrointestinal stromal tumors and effi cacy of endoscopic treatment

目的分析胃肠间质瘤(gastrointestinal stromal tumor,GIST)的临床病理特征,探讨其内镜下治疗的安全性和有效性。方法回顾性分析行内镜下切除治疗的胃肠间质瘤患者138例,分析GIST的临床病理特征、内镜治疗效果、并发症和随访情况。结果138例患者中发现病灶共143个,男女比例1∶1.4,年龄(56.40±8.59)岁。112例(81.2%)患者伴有非特异性消化道症状,其余26例(18.8%)为体检发现。GIST多见于胃底(60.8%),其次以胃体(29.4%),瘤体平均直径约2.1 cm,均为一次性完整切除,手术时间(49.12±8.26)min。术中出血和被动穿孔发生率分别为11.9%(17/143)和9.1%(13/143),术后感染发生率为2.2%(3/138),均经保守治疗后好转出院,无迟发性出血和穿孔。术后平均住院时间为6.2 d。病理免疫组织化学结果示,CD117、CD34和Dog-1阳性率分别为92.3%(132/143)、81.1%(116/143)和89.5%(128/143)。根据NIH危险度分级,极低危96例,低危35例,中危7例。术后随访平均时间为32个月,未见复发和远处转移。结论在严格把握适应证的前提下,直径≤5.5 cm的GIST在内镜下切除是一种安全可行且有效的治疗方式。

Objective To analyze the clinicopathological characteristics of upper gastrointestinal stromal tumor(GIST),and explore the efficacy and safety of endoscopic treatment for GIST.Methods The clinical data of 138 GIST patients who underwent endoscopic treatment were analyzed retrospectively.The incidence rate of complications after endoscopic resection and results of recurrence or metastasis during the follow-up period were analyzed.Results A total of 143 lesions were found in 138 patients,with a male to female ratio of 1∶1.4 and an age of(56.40±8.59)years old.One-hundred-and-twelve patients(81.2%)had nonspecific gastrointestinal symptoms,and the remaining 26 patients(18.8%)were found in physical examination.GIST was most commonly located at the gastric fundus(60.8%),followed by the gastric corpus(29.4%).The average diameter of the tumor was 2.1 cm,and all the tumors were completely excised at one time.The operation time was(49.12±8.26)min.The incidence of intraoperative hemorrhage and accidental perforation were 11.9%(17/143)and 9.1%(13/143),respectively.The postoperative infection rate was 2.2%(3/138).All of the patients recovered uneventfully after conservative treatments,and none of them had postoperative bleeding or other complications.The mean postoperative hospital stay was 6.2 days.Immunohistochemistry results showed that CD117,CD34 and Dog-1 were highly sensitive,with positive rates of 92.3%(132/143),81.1%(116/143)and 89.5%(128/143),respectively.According to the NIH risk classification,96 patients were at extremely low risk,35 at low risk and 7 at moderate risk.The median follow-up time was 32 months,and no recurrence and distant metastasis occurred.Conclusion Endoscopic resection for GIST with diameter≤5.5 cm is a safe,feasible and effective treatment.