胃小间质瘤行内镜下切除治疗的临床价值

Clinical value of endoscopic treatment for small gastric stromal tumor

摘要:

目的 重新评估胃小间质瘤（直径＜2 cm）的潜在风险，评价内镜切除的安全性和有效性，并探讨胃小间质瘤的处置策略。 方法 2008年9月至2015年12月，584例于天津医科大学总医院行内镜黏膜下剥离术（ESD）治疗，并经病理确诊为胃黏膜下肿瘤（SMT）的病例资料纳入回顾性分析，重点调查胃小间质瘤患者的临床和病理特征，并分析其潜在风险；总结ESD的治疗效果、并发症发生情况及术后随访结果，并与同期纳入的45例疑诊为胃小间质瘤而选择定期内镜超声（EUS）监测患者的随访结果进行比较。 结果 584例胃SMT中，间质瘤（239例，40.9％）最为常见，其中203例（84.9％，203／239）属于胃小间质瘤，核分裂象数均≤5／50高倍视野（HPF），但94例（46.3％）有EUS下不良因素，主要包括强回声和异质性，EUS下不良因素与肿瘤的大小有关（P=0.000）。203例胃小间质瘤均成功行ESD，无一例发生严重并发症及围手术期死亡，术后随访12～84个月，81.4％（144／177）的患者术后症状改善，未发现间质瘤复发和转移。45例定期EUS监测的患者中，38例（84.4％）伴有胃肠道症状，随访期间84.2％（32／38）的患者诉症状未得到缓解，12例（26.7％）有较重的的心理负担且严重影响到生活质量。 结论 胃小间质瘤合并EUS下不良因素的发生率高，且随着肿瘤的增大发生率升高。ESD切除胃小间质瘤安全有效，有助于明确诊断，能改善患者症状，减轻心理压力，是一种很好的治疗方式。

Abstract:

Objective To re-evaluate the potential risk of small gastric stromal tumor （diameter less than 2 cm）， and to assess the safety and efficacy of endoscopic resection and further treatment strategy for small gastric stromal tumor. Methods Data of 584 patients undergoing endoscopic submucosal dissection （ESD） and diagnosed as gastric submucosal tumor （SMT） in Tianjin Medical University General Hospital from September 2008 to December 2015 were retrospectively analyzed. The clinical and pathological features and potential risk of small gastric stromal tumor were analyzed. The therapeutic outcomes， complications and follow-up results of ESD were summarized， and the follow-up results of patients undergoing ESD were compared with 45 patients who were suspected as small gastric stromal tumor and followed-up regularly by endoscopic ultrasonography （EUS） in the same period. Results Among 584 cases of gastric SMT， stromal tumor （239 cases， 40.9％） was the most common type， of which small gastric stromal tumor was found in 203 cases （84.9％， 203／239）. The mitotic index of all cases was no more than 5／50 high power field. However， adverse factors under EUS， mainly including strong echo and heterogeneity， were reported in 94 （46.3％） out of 203 cases and were confirmed to be related to tumor size （P=0.000）. ESD was successfully performed in 203 patients with small gastric stromal tumor， and no serious complication or perioperative death occurred. Symptoms of 81.4％ （144／177） patients were improved after ESD， and no stromal tumor recurrence or metastasis was observed during a follow-up of 12-84 months. Of the 45 patients followed-up regularly by EUS， 38 （84.4％） patients had gastrointestinal symptoms and 84.2％ （32／38） were not relieved during follow-up， and 12 （26.7％） had a heavier psychological burden， seriously affecting the quality of life. Conclusion The incidence of adverse factors under EUS is high in patients with small gastric stromal tumor， and increased with tumor size. ESD is safe and effective for small gastric stromal tumor， which contributes to the diagnosis， further improves therapeutic effects and reduces psychological pressure.