较大胃间质瘤内镜手术治疗方法的选择及疗效分析

Selection of endoscopic surgeries for large gastric stromal tumors and the analysis of their effectiveness

目的探讨较大胃间质瘤的消化内镜手术策略,分析内镜手术治疗较大胃间质瘤的临床效果。方法回顾性分析2014年1月至2019年12月在苏州大学附属第一医院、苏州大学附属张家港第一人民医院接受内镜手术的51例胃间质瘤患者的临床资料,根据手术方式不同分为内镜黏膜下剥离术(ESD)组、内镜下全层切除术(EFR)组、黏膜下隧道内镜切除术(STER)组,分析三组患者的肿瘤特征、手术资料及随访资料,并行统计学分析。结果ESD组肿瘤可分布于贲门、胃底、胃体、胃窦,EFR组肿瘤主要位于胃底,少见于胃体及胃窦,STER组肿瘤见于胃体大弯侧及贲门,三组患者肿瘤部位分布比较,差异有统计学意义(P<0.05)。STER组肿瘤最大长径小于EFR、ESD组,差异有统计学意义(P<0.05)。ESD组肿瘤起源于黏膜肌层和黏膜下层,EFR组、STER组肿瘤均起源于固有肌层,三组患者肿瘤起源部位比较,差异有统计学意义(P<0.05)。ESD组、STER组肿瘤均为腔内生长,EFR组肿瘤以腔外生长为主,三组患者肿瘤生长方式比较,差异有统计学意义(P<0.05)。三组患者的肿瘤完整切除率比较,差异无统计学意义(P>0.05)。EFR组并发症发生率高于ESD、STER组,差异有统计学意义(P<0.017)。所有患者术后随访一年,三组患者创面愈合率为100%,均无复发转移情况发生。结论ESD、EFR、STER治疗较大胃间质瘤均有较好的临床效果,可根据肿瘤部位、大小、肿瘤起源及生长方式选择不同内镜治疗术。

Objective To discuss the selection of endoscopic surgery for large gastric stromal tumors and evaluate the clinical efficacy of endoscopic surgery in the treatment of large gastric stromal tumors.Methods The clinical data of 51 patients with gastric stromal tumors who underwent endoscopy in the First Affiliated Hospital of Soochow University and Zhangjiagang First People′s Hospital from January 2014 to December 2019 were retrospectively analyzed.According to different surgical methods,they were divided into endoscopic submucosal dissection(ESD)group,endoscopic full-thickness resection(EFR)group and submucosal tunneling endoscopic resection(STER)group.Tumor characteristics,surgical data and follow-up data of the three groups were analyzed and statistically analyzed.Results The tumors in ESD group were distributed in cardia,fundus,body and antrum.In the EFR group,the tumors were mainly located in the fundus of the stomach,rarely in the body and antrum of the stomach.In the STER group,tumors were found in the greater curvature of the gastric body and the cardia.The distribution of tumor sites in the three groups was significantly different(P<0.05).The maximum diameter of tumors in the STER group was smaller than those in the EFR and ESD group,the difference was statistically significant(P<0.05).The tumors in ESD group originated from muscularis and submucosa,the tumors in EFR group and STER group originated from muscularis propria,and there were significant differences in the origin of tumors among the three groups (P<0.05). The tumors in ESD group and STER group were all intraluminal growth, and the tumors in EFR group were mainly extraluminal growth, there were significant differences in tumor growth patterns among the three groups (P<0.05). There was no significant difference in the complete tumor resection rate among the three groups (P>0.05). The complication rate of EFR group was higher than that of ESD and STER group, the difference was statistically significant (P<0.017). All patients were followed up for one year after operation. The wound healing rate of the three groups was 100%, and there was no recurrence or metastasis. Conclusion ESD, EFR and STER have good clinical effects in the treatment of large gastric stromal tumors. Different endoscopic treatments can be selected according to tumor location, size, tumor origin and growth pattern.