内镜下微创治疗胃间质性肿瘤的疗效和安全性分析  

Curative Efficacy and Safety Analysis of Endoscopic Minimally Invasive Treatment for Gastric Stromal Tumors

作　　者：毛文利 邱志泽 

机构地区：[1]珠海市香洲区人民医院,广东珠海519070 [2]珠海市第二人民医院,广东珠海519000

出　　处：《临床医学工程》2014年第6期763-764,共2页Clinical Medicine & Engineering

摘　　要：目的 探讨内镜下微创治疗胃间质性肿瘤的疗效和安全性。方法 选择我院消化内科2009年4月至2013年3月经超声内镜检查来源于胃固有肌层的GIST的患者，符合入组标准患者24例，其中男14例，女10例；年龄33~67岁，年龄平均52岁。病变位于胃角4例，胃底8例，胃窦8例，胃小弯2例，直径5~22 mm，平均10.9 mm。首先对胃黏膜下病变采用脱气水法行EUS检查，明确病变为起源于胃固有肌层后。采用结扎、切开、剥离、创面处理、病理检测等处理，观察治疗效果及评价其安全性。结果 24例肿瘤均位于胃固有肌层，22例在内镜下完整切除，2例无法完全切除。术后病理组织学及免疫组织化学检查确诊胃间质性肿瘤16例，均为极低及低度恶性间质瘤；胃平滑肌瘤4例，胃神经纤维瘤2例，胃血管球瘤2例。术后无继发胃穿孔、胃出血等严重并发症，术后随访24例，创面均愈合，无复发病例。结论 胃镜微创治疗小的胃间质性肿瘤安全、有效，预后良好。Objective To explore the curative effect and safety of endoscopic minimally invasive treatment for gastrointestinal stromal tumors. Methods 24 patients with SMT were selected in our depatment gastroenterology from April 2009 to March 2013 who were confimed with SMT from stomach muscularis propria through EUS, including 14 male cases, 10 female cases. The patients were aged from 33 to 67, with the average age of 52. Lesions located in the stomach angle （4 cases）, fundus of stomach （8 cases）, gastric antrum （8 cases）, curvatura veutriculi minor （2 cases）, with a diameter of 5 ~ 22 mm, the average of 10.9 mm. Firstly, EUS by de-aerated water was implemented to the gastric submucosal lesions to confirm that the lesions stem from stomach muscularis propria . Then the leisions were treated with ligation, cutting, stripping, wound treatment and pathological detection. The primary outcome was an evaluation of the clinical efficacy and safety of the treatment. Results 24 cases of tumors were located in the muscularis propria, with 22 cases which were treated with complete endoscopic excision and 2 cases which cannot be completely removed. Postoperative pathological histology and immunohistochemical examination confirmed 16 cases of gastric stromal tumor which was extremely low or low-grade malignant stromal tumors, 4 cases of gastric leiomyoma, 2 case s of neurofibroma, 2 case s of gastric glomus tumor. No postoperative secondary gastric perforation, severe stomach bleeding and other complications occured. In the postoperative follow-up of 24 cases, wounds were healed, with no recurrence. Conclusions Endoscopic minimally invasive treatment for small gastric stromal tumor is safe, effective, with good prognosis.

关 键 词：胃间质性肿瘤 内镜超声 治疗 

分 类 号：R730.56[医药卫生—肿瘤] R735.2[医药卫生—临床医学]