胃小间质瘤特征及内镜治疗必要性

Characteristics of small gastric stromal tumor and necessity of endoscopic treatment

目的探讨直径≤1cm的胃小间质瘤是否有超级微创手术(SMIS)治疗的必要性及如何选择其术式。方法回顾性收集2008—2023年就诊于解放军总医院第一医学中心行SMIS治疗的直径≤1cm的胃小间质瘤患者共111例,根据内镜治疗方法不同分为内镜黏膜下剥离术和经内镜隧道下肿瘤剥离术组、内镜黏膜下挖除术组、内镜下全层切除术组,分析三组患者的一般特征及病理学特征,对比不同内镜治疗术式的差异性,随访患者术后转移情况。结果纳入的111例患者均为极低风险胃间质瘤,多见于中老年患者,发生部位主要为胃底,多数患者免疫组织化学结果中CD34、CD117、DOG-1、PDGFR-a阳性及Ki-67(+≤5%)较为多见,三组患者的一般资料及病理学资料比较差异无统计学意义(P>0.05),术后均未见严重并发症及复发转移。结论对于直径≤1 cm的胃小间质瘤患者,消化内镜超级微创是安全有效的治疗措施,创伤小,恢复快,随着消化内镜技术的逐渐发展,SMIS会越来越多地成为胃小间质瘤患者的首选治疗。

Objective To discuss the necessary of digestive endoscopic super minimally invasive resection(SMIS)treatment for the patients with small gastric stromal tumors≤1 cm in diameter and how to choose the endoscopic treatment methods.Methods The patients who underwent digestive endoscopic SMIS treatment at the First Medical Center of the PLA General Hospital from July 2008 to September 2023 were enrolled retrospectively.According to different endoscopic treatment methods,the patients were divided into endoscopic submucosal dissection(ESD)and endoscopic submucosal tunneling for tumor dissection(STER)group,endoscopic submucosal excision(ESE)group and endoscopic full-thickness resection(EFR)group.The general and pathological characteristics of these patients were analyzed,the differences of different endoscopic treatment methods were compared,and the postoperative metastases of patients were followed up.Results The 111 patients included were all very low-risk gastric stromal tumors,which were mostly found in middle-aged and elderly patients and mainly occurred in the gastric fundus.Immunohistochemical results of most patients showed positive CD34,CD117,DOG-1,PDGFR-a and Ki-67(+≤5%),and there were no significant difference in general and pathological data between the three groups(P>0.05).No serious complications and recurrence were observed.Conclusions For patients with small gastric stromals tumors≤1 cm,digestive endoscopic SMIS is a safe and effective treatment measure with less trauma and faster recovery.With the rapid development of digestive endoscopy technology,SMIS will increasingly become the first choice of treatment for patients with small gastric stromal tumors.