术前超声内镜对胃间质瘤的诊断及侵袭危险性评估价值研究  

Evaluation of preoperative endoscopic ultrasonography for diagnosis and invasive risk assessment of gastric gastrointestinal stromal tumors：a single-center retrospective study

作　　者：彭春艳[1] 吕瑛[1] 徐桂芳[1] 凌亭生[1] 王雷[1] 余德才[2] 沈珊珊[1] 邹晓平[1] 张晓琦[1] 

机构地区：[1]南京大学医学院附属鼓楼医院消化科,南京210008 [2]南京大学医学院附属鼓楼医院普外科,南京210008

出　　处：《中华消化内镜杂志》2015年第6期361-366,共6页Chinese Journal of Digestive Endoscopy

基　　金：国家青年自然科学基金资助项目（81201908）;南京市医学科技发展项目（YKK14061）

摘　　要：目的探讨术前超声内镜检查术（EUS）对胃间质瘤的诊断及侵袭危险性评估的价值。方法回顾性分析248例我院EUS拟诊为胃间质瘤并有明确病理诊断的患者，评估术前EUS诊断胃间质瘤和术后病理诊断的符合率及可能的影响因素，同时比较不同侵袭危险性胃间质瘤的EUS特征。结果术前EUS诊断胃间质瘤和术后病理诊断符合率为67．7％（168／248）。单因素分析显示肿瘤直径、存在黏膜桥、内部回声不均匀以及病灶钙化与诊断符合率显著相关，多因素分析显示仅内部回声不均匀（OR=2．53，95％CI：1．23～5．18，P=0．011）和病灶钙化（OR=2．25，95％CI：1．34～6．56，P=0．045）是影响EUS诊断符合率的独立因素。168例胃间质瘤中极低度侵袭危险性63例，低度侵袭危险性62例，中度侵袭危险性26例，高度侵袭危险性17例。侵袭危险性越高的胃问质瘤其溃疡、内部回声不均匀及钙化现象越常见。多因素分析显示仅肿瘤直径（P〈0．0001）是预测胃间质瘤较高侵袭危险性的独立危险因素。结论术前EUS对胃间质瘤的诊断及侵袭危险性评估有一定作用，可为临床医师选择合适的治疗方案提供信息。Objective To evaluate preoperative endoscopic uhrasonography（EUS） for diagnosis and invasive risk assessment of gastric gastrointestinal stromal tumors （GISTs）. Methods A total of 248 patients diagnosed as having gastric GISTs based on preoperative EUS and with established pathologic results at our institution were recruited to the study. The coincidence rates for gastric GISTs between preoperative EUS and pathologic results were calculated. Univariate and multivariate analyses were used to explore the possible pre- dictors for the coincidence rates. EUS features were compared according to histological risk classification of very low/low risk malignant potential or intermediate/high risk malignant potential. Results The overall co- incidence rate for gastric GISTs between EUS and pathologic results was 67. 7% （168/248）. Univariate anal- ysis showed that tumor diameter, mucosal bridge, heterogeneity, and calcification were significantly correla- ted with the coincidence rate for gastric GISTs between preoperative EUS and pathologic results. Multivariate analysis indicated that heterogeneity （ OR = 2. 53, 95% CI： 1.23-5. 18, P = 0. 011 ） and calcification（ OR = 2. 25, 95% CI： 1.34-6. 56 ,P = 0. 045） were the independent factors for the coincidence rate. A total of 168 patients were divided into four groups according to histological risk： very low risk （n = 63 ）, low risk （n = 62）, intermediate risk （n = 26）, and high risk （n = 17 ）. Gastric GISTs with heterogeneity, mucosal ulceration, and calcification on EUS suggested higher risk GISTs. Multivariate analysis indicated that only tumor diameter（P 〈 0. 000 1 ）could predict malignant potential of gastric GISTs. Conclusion Preoperative EUS plays an role in diagnosing and evaluating of invasive risk for gastric GISTs, which might aid the clinical management of gastric GISTs.

关 键 词：危险性评估 间质瘤 腔内超声检查 

分 类 号：R735.2[医药卫生—肿瘤]