139例胃间质瘤的临床诊治分析

Clinical diagnosis and treatment of 139 cases of gastric stromal tumor

目的:探讨胃间质瘤(GST)的发病特点、临床表现、内镜下切除术治疗的安全性。方法:对2016年1月至2020年12月在东南大学附属中大医院住院并经病理及免疫组化确诊为GST的139例患者进行分析,患者术前均行白光内镜、超声内镜、腹部CT检查评估病灶,记录肿瘤大小及部位、手术方式、手术时间、术后并发症、病理等情况。结果:139例GST患者均无远处转移,发生于胃底91例(65.46%),胃体35例(25.18%);年龄37~87岁,平均(60.97±10.12)岁;肿瘤直径为0.5~6.0 cm,平均(2.03±1.47)cm。97例患者表现为不同程度的上腹部不适(69.78%),超声胃镜检查发现病变起源于固有肌层135例(97.12%);瘤体直径<1.5 cm者,CT检查多无阳性表现。136例经内镜完整切除者中肿瘤直径≥2 cm者52例,最大直径6 cm,术中及术后未发生不可控制的出血及穿孔,另3例行腹腔镜下治疗。结论:GST好发于胃底部,临床症状主要表现为不同程度的上腹部不适,部分无症状由体检发现。病变多起源于固有肌层,当病灶>1.5 cm时腹部CT可呈结节样突起或占位性改变。对直径≤6 cm且无远处转移的GST可考虑行内镜下切除术。

Objective:To investigate the clinical features and safety of endoscopic resection of gastric stromal tumor.Method:Based on the analysis of 139 patients who were diagnosed as gastric stromal tumor by pathology and immunohistochemistry in Zhongda Hospital of Southeast University from January 2016 to December 2020.The lesions were evaluated by white light endoscopy,ultrasound endoscopy and abdominal CT before surgery,and the tumor size,location,operation method,operation time,postoperative complications and pathology were recorded.Result:No distant metastasis was found in 139 patients.There were 91 patients(65.46%)with fundus stromal tumor and 35 patients(25.18%)with gastric body.The age was 37-87 years and the mean age was(60.97±10.12)years.The tumor diameter ranged from 0.5-6.0 cm,with an average diameter of(2.03±1.47)cm.97 patients presented varying degrees of upper abdominal discomfort(69.78%).135 patients(97.12%)showed lesions originating from the muscularis propria under ultrasound gastroscopy.If the tumor diameter was less than 1.5 cm,most patients showed no positive results on CT examination.Among 136 cases of complete endoscopic resection,diameter of 52 cases≥2 cm,and the maximum diameter was 6 cm.No uncontrolled bleeding or perforation occurred during and after operation,and the other 3 cases were treated by laparoscopy.Conclusion:Gastric stromal tumor is more common in the fundus of the stomach,presenting with different degrees of upper abdominal discomfort,some asymptomatic by physical examination.Most of the lesions originated from the muscularis propria.When the lesion was larger than 1.5 cm,abdominal CT could show nodular protrusion or space-occupying changes.Endoscopic mucosal dissection and extension resection is a safe and effective method for the treatment of gastric stromal tumors,which can be considered for gastric stromal tumor with diameter≤6 cm and no distant metastasis.