胃间质瘤的临床病理特征及内镜下治疗评价
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摘要
目的分析胃间质瘤的临床病理特征以提高对胃间质瘤的认识,评价内镜下治疗胃间质瘤的安全性与疗效,探讨内镜下治疗并发症的可能危险因素。方法回顾性分析在我院行内镜下治疗且病理确诊为胃间质瘤的136例患者的资料,分析患者临床病理特征、治疗情况、并发症情况。结果 136例胃间质瘤患者中共发现胃间质瘤138个,34例(34个瘤体)行EFTR治疗,一次完整切除率100%(34/34),其中2例发生术中活动性出血,1例发生术后穿孔及迟发性出血; 102例(104个瘤体)行ESD治疗,一次完整切除率99. 0%(103/104),其中10例发生术中穿孔,1例发生术中出血,3例发生术后迟发性出血; ESD组术后感染率小于EFTR组(P=0. 001);单因素分析显示:ESD治疗发生迟发性出血在不同病灶部位(P <0. 001)及瘤体大小(P=0. 003)方面差异有统计学意义。结论胃间质瘤内镜下治疗安全、有效,ESD与EFTR治疗疗效相当,对位于胃底胃体交界处、直径在2～5 cm之间的瘤体易出现ESD术后迟发性出血。
Objective To analyze the clinicopathological features of gastric stromal tumors in order to improve the understanding of them,to evaluate the safety and efficacy of endoscopic treatment of gastric stromal tumors,and to explore the possible risk factors of complications of endoscopic treatment. Methods Data of 136 patients diagnosed gastric stromal tumors and treated by endoscopic treatment in our hospital were reviewed. The clinicopathological characteristics,treatment and complications were analyzed. Results In 136 patients,138 tumors were found. Thirtyfour patients( 34 tumors) were treated with EFTR. The complete resection rate was 100%( 34/34),2 patients suffered intraoperative active bleeding,1 patient suffered postoperative perforation and delayed bleeding. One hundred and two patients( 104 tumors) were treated with ESD. The complete resection rate was 99. 0%( 103/104). Ten patients suffered intraoperative perforation,1 patients suffered intraoperative bleeding,3 patients suffered postoperative delayed bleeding. The infection rate of ESD group was less than that of EFTR group( P = 0. 001). The single factor analysis showed that there was significant difference in the lesion location( P < 0. 001) and the size of tumor( P = 0. 003) in the ESD treatment. Conclusion Endoscopic therapy for gastric stromal tumors is safe and effective. The treatment efficacy between ESD and EFTR for treating gastric stromal tumors is comparable. For patients with gastric stromal tumors located at gastric fundus junction,diameters from 2 cm to 5 cm may be prone to delayed bleeding.
Objective To analyze the clinicopathological features of gastric stromal tumors in order to improve the understanding of them,to evaluate the safety and efficacy of endoscopic treatment of gastric stromal tumors,and to explore the possible risk factors of complications of endoscopic treatment. Methods Data of 136 patients diagnosed gastric stromal tumors and treated by endoscopic treatment in our hospital were reviewed. The clinicopathological characteristics,treatment and complications were analyzed. Results In 136 patients,138 tumors were found. Thirtyfour patients( 34 tumors) were treated with EFTR. The complete resection rate was 100%( 34/34),2 patients suffered intraoperative active bleeding,1 patient suffered postoperative perforation and delayed bleeding. One hundred and two patients( 104 tumors) were treated with ESD. The complete resection rate was 99. 0%( 103/104). Ten patients suffered intraoperative perforation,1 patients suffered intraoperative bleeding,3 patients suffered postoperative delayed bleeding. The infection rate of ESD group was less than that of EFTR group( P = 0. 001). The single factor analysis showed that there was significant difference in the lesion location( P < 0. 001) and the size of tumor( P = 0. 003) in the ESD treatment. Conclusion Endoscopic therapy for gastric stromal tumors is safe and effective. The treatment efficacy between ESD and EFTR for treating gastric stromal tumors is comparable. For patients with gastric stromal tumors located at gastric fundus junction,diameters from 2 cm to 5 cm may be prone to delayed bleeding.
引文
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[15] TOYOKAWA T,INABA T,OMOTE S,et al. Risk factors for perfo-ration and delayed bleeding associated with endoscopic submucosaldissection for early gastric neoplasms:analysis of 1123 lesions[J]. JGastroenterol Hepatol,2012,27(5):907-912. DOI:10. 1111/j.1440-1746. 2011. 07039. x.
[2] S?REIDE K,SANDVIK O M,S?REIDE J A,et al. Global epidemi-ology of gastrointestinal stromal tumours(GIST):a systematic reviewof population-based cohort studies[J]. Cancer Epidemiol,2016,40:39-46. DOI:10. 1016/j. canep. 2015. 10. 031.
[3] YANG F,JIN C,DU Z,et al. Duodenal gastrointestinal stromaltumor:clinicopathological characteristics,surgical outcomes,long termsurvival and predictors for adverse outcomes[J]. Am J Surg,2013,206(3):360-367. DOI:10. 1016/j. amjsurg. 2012. 11. 010.
[4] FENG F,TIAN Y,LIU Z,et al. Clinicopathologic features and clini-cal outcomes of esophageal gastrointestinal stromal tumor:evaluation ofa pooled case series[J]. Medicine(Baltimore),2016,95(2):e2446. DOI:10. 1097/MD. 0000000000002446.
[5] MARANO L,BOCCARDI V,MARRELLI D,et al. Duodenal gastro-intestinal stromal tumor:from clinicopathological features to surgicaloutcomes[J]. Eur J Surg Oncol,2015,41(7):814-822. DOI:10.1016/j. ejso. 2015. 04. 004.
[6] QUMSEYA B J,WOLFSEN C,WANG Y,et al. Factors associatedwith increased bleeding post-endoscopic mucosal resection[J]. J DigDis,2013,14(3):140-146. DOI:10. 1111/1751-2980. 12002.
[7] MIETTINEN M,LASOTA J. Succinate dehydrogenase deficient gastro-intestinal stromal tumors(GISTs)-a review[J]. Int J Biochem CellBiol,2014,53:514-519. DOI:10. 1016/j. biocel. 2014. 05. 033.
[8] YEH C H,PAN K T,CHU S Y,et al. Safety and efficacy of image-guided percutaneous biopsies in the diagnosis of gastrointestinal stromaltumors[J]. Clin Imaging,2012,36(1):19-23. DOI:10. 1016/j.clinimag. 2011. 04. 002.
[9]吴龙云,彭春艳,吕瑛,等.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[J].中华消化内镜杂志,2016,33(7):442-446. DOI:10. 3760/cma. j. issn. 1007-5232. 2016.07. 005.WU L Y,PENG C Y,LYU Y,et al. Evaluation of clinical treatmentof primary small gastric gastrointestinal stromal tumors:a retrospectivesingle-center study[J]. Chin J Dig Endosc,2016,33(7):442-446.DOI:10. 3760/cma. j. issn. 1007-5232. 2016. 07. 005.
[10] TAN Y,TAN L,LU J,et al. Endoscopic resection of gastric gastro-intestinal stromal tumors[J]. Transl Gastroenterol Hepatol,2017,2:115. DOI:10. 21037/tgh. 2017. 12. 03.
[11] TAN Y,TANG X,GUO T,et al. Comparison between submucosal tun-neling endoscopic resection and endoscopic full-thickness resection forgastric stromal tumors originating from the muscularis propria layer[J].Surg Endosc,2017,31(8):3376-3382. DOI:10. 1007/s00464-016-5350-7.
[12] CATALANO F,RODELLA L,LOMBARDO F,et al. Endoscopicsubmucosal dissection in the treatment of gastric submucosal tumors:results from a retrospective cohort study[J]. Gastric Cancer,2013,16(4):563-570. DOI:10. 1007/s10120-012-0225-7.
[13] ODA I,SUZUKI H,NONAKA S,et al. Complications of gastric en-doscopic submucosal dissection[J]. Dig Endosc,2013,25 Suppl 1:71-78. DOI:10. 1111/j. 1443-1661. 2012. 01376. x.
[14] OKADA K,YAMAMOTO Y,KASUGA A,et al. Risk factors for de-layed bleeding after endoscopic submucosal dissection for gastric neo-plasm[J]. Surg Endosc,2011,25(1):98-107. DOI:10. 1007/s00464-010-1137-4.
[15] TOYOKAWA T,INABA T,OMOTE S,et al. Risk factors for perfo-ration and delayed bleeding associated with endoscopic submucosaldissection for early gastric neoplasms:analysis of 1123 lesions[J]. JGastroenterol Hepatol,2012,27(5):907-912. DOI:10. 1111/j.1440-1746. 2011. 07039. x.