173例胃平滑肌瘤诊治分析  

Diagnosis and treatment of 173 cases of gastric leiomyoma

作　　者：钟宇新 金鹏 楚江涛 熊建平 李洋 康文哲 田艳涛 Zhong Yuxin;Jin Peng;Chu Jiangtao;Xiong Jianping;Li Yang;Kang Wenzhe;Tian Yantao(Department of Pancreatic and Gastric Surgery,National Cancer Center,National Clinical Research Center for Cancer,Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Department of Endoscope,National Cancer Center,National Clinical Research Center for Cancer,Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)

机构地区：[1]国家癌症中心国家肿瘤临床医学研究中心中国医学科学院北京协和医学院肿瘤医院胰胃外科,北京100021 [2]国家癌症中心国家肿瘤临床医学研究中心中国医学科学院北京协和医学院肿瘤医院腔镜科,北京100021

出　　处：《中国医学前沿杂志（电子版）》2021年第9期49-52,共4页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

基　　金：吴阶平医学基金会临床科研专项资助基金(320.6750.17225)。

摘　　要：目的探讨胃平滑肌瘤的病例特点及其诊治方式。方法回顾性分析2000年1月至2020年12月中国医学科学院北京协和医学院肿瘤医院收治的173例行手术治疗的胃平滑肌瘤患者的临床病历资料。结果患者平均年龄为54(22~78)岁,男女比例为1.2∶1.0。155例发生于贲门,占89.60%;肿瘤最大径为2.0(0.2~8.0)cm,68例行内镜下黏膜剥离术,6例行胸腔镜手术,13例行腹腔镜手术,86例行开放手术;共74例行肿物部分切除术,99例行近端胃切除术。术后病理结果显示:17例(9.83%)为平滑肌瘤合并腺癌,10例(5.78%)为平滑肌瘤合并鳞癌,2例(1.16%)为平滑肌瘤合并腺鳞癌,该29例患者术前均被诊断为胃恶性肿瘤,术后病理发现合并平滑肌瘤;1例(0.58%)为平滑肌瘤合并间质瘤,而143例(82.66%)单纯胃平滑肌瘤中有56例(39.16%)术前被诊断为间质瘤。单纯平滑肌瘤超声内镜下多表现为表面光滑、无溃疡、边界清楚、形状规则、低回声、来源于固有肌层。CT表现为密度均匀、长径/短径>1.5、延迟强化的特点。结论胃平滑肌瘤多位于黏膜肌层和固有肌层,可与胃癌或胃间质瘤伴发,易被误诊为胃肠间质瘤而行手术治疗,掌握其影像学特点有助于鉴别诊断。Objective To investigate the characteristics,diagnosis and treatment of gastric leiomyoma.Method The clinicopathological data of 173 patients with gastric leiomyoma admitted to Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College from January 2000 to December 2020 were retrospectively analyzed.Result The mean age of patients was 54(22~78)years old,and the male to female ratio was 1.2∶1.0.One hundred and fifty-five cases occurred in cardia,accounted for 89.60%;the average tumor size was 2.0(0.2~8.0)cm.There were 68 cases of endoscopic mucosal dissection,6 cases of thoracoscopic surgery,13 cases of laparoscopic surgery,and 86 cases of open surgery.A total of 74 cases of partial resection and 99 cases of proximal gastrectomy were performed.In postoperative pathology,17 cases(9.83%)were leiomyoma complicated with adenocarcinoma,10 cases(5.78%)were leiomyoma complicated with squamous cell carcinoma,2 cases(1.16%)were leiomyoma complicated with adenosquamous cell carcinoma.All the 29 patients were diagnosed as gastric malignant tumor preoperatively,and postoperative pathology was found to be complicated with leiomyoma;1 case(0.58%)was leiomyoma complicated with stromal tumor.Among 143 cases(82.66%)with simple gastric leiomyoma,56 cases(39.16%)were diagnosed as mesenchymal tumors preoperatively.Under endoscopic ultrasound,simple leiomyoma showed smooth surface,no ulceration,clear boundary,regular shape,low echo,and originated from the muscularis propria.CT findings were characterized by uniform density,long diameter/short diameter>1.5,and delayed enhancement.Conclusion Gastric leiomyoma is mainly located in the muscularis mucosa and the muscularis propria,which is easy to be misdiagnosed as gastrointestinal stromal tumor for surgical treatment.Endoscopic ultrasonography combined with enhanced CT can improve the diagnostic rate and avoid unnecessary surgery.

关 键 词：胃平滑肌瘤 异位胰腺 间质瘤 神经鞘瘤 超声内镜 CT 

分 类 号：R735.2[医药卫生—肿瘤]