原发性胃小间质瘤的临床处理及评价：一项单中心的回顾性研究  

Evaluation of clinical treatment of primary small gastric gastrointestinal stromal tumors ： a retrospec-tive single-center study

作　　者：吴龙云[1] 彭春艳[1] 吕瑛[1] 张晓琦[1] 凌亭生[1] 张以洋[1] 王雷[1] 余德才[2] 杨天[1] 沈珊珊[1] 邹晓平[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》2016年第7期442-446,共5页Chinese Journal of Digestive Endoscopy

基　　金：基金项目：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：目的探讨原发性胃小间质瘤的临床和病理特点，并评价以ESD为基础的内镜下切除术治疗的疗效和安全性。方法2012年1月至2015年6月，143例在南京大学医学院附属鼓楼医院接受内镜下治疗（内镜治疗组，n=107）或外科手术（外科手术组，n=36）的原发性胃小间质瘤患者纳入回顾性研究，总结其临床和病理特征，并对2组的效果指标（手术切除情况和并发症）及预后进行对比分析。结果（1）143例患者中，大多数患者（79．7％）无临床表现，病灶多位于胃底（53．8％），中位直径1．3cm，术前内镜超声均提示低度侵袭危险性，术后病理提示112例（78．3％）呈极低度侵袭危险性、24例（16．8％）呈低度侵袭危险性、4例（2．8％）呈中度侵袭危险性、3例（2．1％）呈高度侵袭危险性，且中度及高度侵袭危险性仅发生于直径〉1-2cm的患者中。（2）内镜治疗组和外科手术组的病灶完整切除率相近（90．7％比100．0％），前者中位住院时间更短（5d比8d，P〈0．001）、术后感染发生率更低（0．9％比19．4％），术后随访期间（中位随访时间24个月）均未发现复发或转移。结论胃小间质瘤易发于胃底，患者多无明显临床表现，多呈极低或低度侵袭危险性，但术前内镜超声对其评估价值有限。在确保完整切除的前提下，以ESD为基础的内镜下切除术治疗原发性胃小间质瘤是安全和可行的。Objective To investigate the clinicopathologic features of primary small gastrointestinal stromal tumors （GISTs） and to evaluate the efficacy and safety of endoscopic resection based on ESD. Methods A retrospective analysis was performed in patients with pathologically proved small GISTs who un- derwent endoscopic resection （n = 107） or surgery including open laparotomy or laparoscopie surgery （n = 36） at Drum Tower Hospital from January 2012 to June 2015.The clinicopathologic features, treatment, adverse e- vents, and prognosis were evaluated. Results 1 ） A total of 143 patients were included in the study, 79. 7% of whom with small GISTs were asymptomatic. Approximately 53.8% of GISTs occurred in the fundus of stom- ach. The median tumor size was 1.3 em. Preoperative endoscopic uhrasonography （EUS） revealed they were all classified as very low risk. Histological examinations showed that 112 （78. 3%） patients were classified as very low risk, 24 （16. 8%） as low risk, 4 （2. 8%） as moderate risk and 3 （2. 1%） as high risk. Subgroup a- nalysis suggested that the size of GISTs classified in moderate or high risk ranged from 1 to 2 cm. 2） The com- plete resection rate was close, 90. 7% in endoscopy group and 100% in surgery group, respectively. Hospital stay was shorter in endoscopy group than that in surgery group （5 d VS 8 d, P〈0. 001 ）. And the incidence ofpostoperative infection was lower in endoscopic group than in surgical group （0.9% VS 19.4%）. No recurrence or metastasis wa,~ detected, with the median follow-up period of 24 months. Conclusion In most of the cases, small gastric gastrointestinal stromal tumors occur in the fundus of stomach. Most patients with GISTs are asymptomatic, most of which are classified as very low risk or low risk. Preoperative EUS has a lim- ited value in evaluating inwtsive risk of small gastric GISTs. Endoscopic therapy based on ESD is feasible and safe in nmnaging small gastric GISTs if complete resection can be assured.

关 键 词：胃小间质瘤 内窥镜检查 超声检查 内镜黏膜下剥离术 回顾性研究 

分 类 号：R735.2[医药卫生—肿瘤]