上消化道固有肌层肿瘤经内镜黏膜下隧道肿瘤切除效果与患者APACHEⅡ评分及预后的关系
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摘要
[目的]探讨内镜经黏膜下隧道肿瘤切除术(STER)、免疫组化、慢性健康评分系统与上消化道固有肌层肿瘤患者预后的相关性。[方法]回顾分析2017年1月～2018年1月我院消化内科收治的52例经胃镜、超声证实上消化道固有肌层肿瘤患者的临床资料,依据手术方式不同,分为STER组和开腹组,每组各为26例。采用免疫组化法检测结蛋白、肌动蛋白、波形蛋白、CD_(117)、CD_(34)以及S-100的表达,并进行APACHEⅡ评分的统计分析,消化道固有肌层肿瘤患者预后的影响因素,采用Cox比例风险回归模型。[结果]STER组CD_(117)、CD_( 34)、波形蛋白阳性检出率高于与开腹组(P<0.01),差异有统计学意义,而结蛋白、肌动蛋白略高于开腹组,差异有统计学意义(P<0.05),S-100阳性检出率与开腹组比较,差异无统计学意义;STER组并发症发生率为30.76%,显著低于开腹组61.54%,而且胃排空障碍、穿孔率、术中大出血、纵隔感染,差异有统计学意义(P<0.05),而食管瘘、肺部感染无显著差异;STER慢性生理评分(MAP、HR)、年龄评分,与开腹组比较差异无统计学意义,而急性评分、RR评分、PAO_2评分以及APACHEⅡ总评分,差异有统计学意义(P<0.05)。将上述统计学意义的因素作为变量,进行非条件逐步回归分析;结果显示,ALK、CD_(30)、EMA、CD_2、CD_(45)RO、肿瘤总数、穿孔率、切除肿瘤直径、并发症率、APACHEⅡ评分和心率失常与上消化道固有肌层肿瘤患者预后存在显著相关性,为危险因素。[结论]STER、免疫组化、慢性健康评分系统与消化道固有肌层肿瘤患者预后存在显著相关性,APACHEⅡ评分和免疫组化分析,准确地进行肿瘤清扫,降低并发症和复发率,提高患者术后生存质量。
[Objective] To investigate the relationship among APACHEⅡ score,Endoscopic Submucosal Tunnel Tumor Resection effect for Muscle-layer Tumors of the Upper Gastrointestinal Tract and Prognosis.[Methods]To retrospectively analyze the clinical data of 52 patients with upper gastrointestinal intrinsic muscular tumors confirmed by gastroscopy and ultrasonography from January 2017 to January 2018 were.According to different surgical methods,26 patients were treated with STER and 26 patients were treated with open surgery.Use immunohistochemistry to detect the expressions of ALK,CD_(30),EMA,CD_2,CD_(45)RO and CD_(20),and statistical analysis The APACHEⅡ scores.Take Cox proportional risk regression model to analyze the prognostic factors of patients with gastrointestinal intrinsic muscular tumors.[Results]The positive detection rates of CD_(117),CD_( 34) and vimentin in STER group were higher than those in open group(P<0.01)with significant difference,while desmin and actin were slightly higher than those in open group(P<0.05).There was no significant difference in S-100 positive detection rate between STER group and open group.The incidence of complications in STER group was 30.76%,significantly lower than that in open group(61.54%).There were significant differences in gastric emptying disorder,perforation rate,intraoperative massive hemorrhage and mediastinal infection(P<0.05),but no significant differences in esophageal fistula and pulmonary infection.There were no significant differences in STER chronic physiological score(MAP,HR)and age score(all P>0.05),while there were significant differences in acute score,RR score,PAO_( 2) score and APACHE II total score(P<0.05).The results showed that gastric emptying disturbance rate,perforation rate,desmin positive rate,actin positive rate,vimentin positive rate,CD_(34) positive rate,CD_(117) positive rate,mediastinal infection,massive hemorrhage rate,APACHE II score,total number of muscular tumors were significantly correlated with the prognosis of patients with upper gastrointestinal intrinsic muscular tumors,which were risk factors.[Conclusion]STER,immunohistochemistry and chronic health scoring system are significantly correlated with the prognosis of patients with gastrointestinal intrinsic muscular layer tumors.APACHEⅡ score and immunohistochemistry analysis can accurately perform tumor clearance,reduce complications and recurrence rate,and improve the quality of life of patients after operation.
[Objective] To investigate the relationship among APACHEⅡ score,Endoscopic Submucosal Tunnel Tumor Resection effect for Muscle-layer Tumors of the Upper Gastrointestinal Tract and Prognosis.[Methods]To retrospectively analyze the clinical data of 52 patients with upper gastrointestinal intrinsic muscular tumors confirmed by gastroscopy and ultrasonography from January 2017 to January 2018 were.According to different surgical methods,26 patients were treated with STER and 26 patients were treated with open surgery.Use immunohistochemistry to detect the expressions of ALK,CD_(30),EMA,CD_2,CD_(45)RO and CD_(20),and statistical analysis The APACHEⅡ scores.Take Cox proportional risk regression model to analyze the prognostic factors of patients with gastrointestinal intrinsic muscular tumors.[Results]The positive detection rates of CD_(117),CD_( 34) and vimentin in STER group were higher than those in open group(P<0.01)with significant difference,while desmin and actin were slightly higher than those in open group(P<0.05).There was no significant difference in S-100 positive detection rate between STER group and open group.The incidence of complications in STER group was 30.76%,significantly lower than that in open group(61.54%).There were significant differences in gastric emptying disorder,perforation rate,intraoperative massive hemorrhage and mediastinal infection(P<0.05),but no significant differences in esophageal fistula and pulmonary infection.There were no significant differences in STER chronic physiological score(MAP,HR)and age score(all P>0.05),while there were significant differences in acute score,RR score,PAO_( 2) score and APACHE II total score(P<0.05).The results showed that gastric emptying disturbance rate,perforation rate,desmin positive rate,actin positive rate,vimentin positive rate,CD_(34) positive rate,CD_(117) positive rate,mediastinal infection,massive hemorrhage rate,APACHE II score,total number of muscular tumors were significantly correlated with the prognosis of patients with upper gastrointestinal intrinsic muscular tumors,which were risk factors.[Conclusion]STER,immunohistochemistry and chronic health scoring system are significantly correlated with the prognosis of patients with gastrointestinal intrinsic muscular layer tumors.APACHEⅡ score and immunohistochemistry analysis can accurately perform tumor clearance,reduce complications and recurrence rate,and improve the quality of life of patients after operation.
引文
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[10] 徐美东,陆巍,李全林,等.内镜经黏膜下隧道肿瘤切除术在胃固有肌层肿瘤中的应用与评价[J].中华胃肠外科杂志,2012,15(7):671-674.
[11] 姜海行,覃山羽,黄杰安,等.经内镜黏膜下隧道肿瘤切除术治疗上消化道黏膜下肿瘤的应用研究[J].微创医学,2013,8(6):660-664.
[12] 闫晓红,赵亚宁,汪华等.替吉奥与三维适形放射用于消化道恶性肿瘤临床治疗价值研究[J].中国中西医结合消化杂志,2018,26(02):163-166.
[13] 何池义,韩真,李芳芳,等.内镜超声检查在上消化道粘膜下肿瘤微创治疗中的价值研究[J].中华消化内镜杂志,2010,27:134-137.
[14] 王轶.经胃镜保留浆膜层切除上消化道固有肌层起源肿瘤技术初探[J].中华消化内镜杂志,2018,35(1):23-26.
[15] 余小冬,金晓燕.谷氨酰胺营养支持对胃肠道恶性肿瘤恶液质患者血清细胞因子水平的影响[J].中国中西医结合消化杂志,2018,7(4):364-366.
[16] 刘锦涛,余细球,侯华君,等.超声内镜对内镜治疗消化道隆起性病变的指导价值[J].中国内镜杂志,2008,14(3):243-248.
[2] Joensuu H,Hohenberger P,Corless CL.Gastrointestinal stromal tumour[J].Lancet,2013,382(9896):973-983.
[3] Huang ZG,Zhang XS,Huang SL,et al.Endoscopy dissection ofsmall stromal tumors emerged from the muscularis propria in the upper gastrointestinal tract Preliminary study[J].World J Gastrointest Endosc,2012,4(12):565-570.
[4] Chun SY,Kim KO,Park DS,et al.Endoscopic submucosal dissection as a treatment for gastric subepithelial tumors that originate from the muscularis propria layer:a preliminary analysis of appropriate indications[J].Surg Endosc,2013,27(9):3271-3279.
[5] Chu YY,Lien JM,Tsai MH,et al.Modified endoscopic submucosal dissection with enucleation for treatment of gastric subepithelial tumors originating from the muscularis propria layer[J].BMC Gastroenterol,2012,12:124.
[6] 刘煜蕾.研究APACHEⅡ评分在综合ICU产科危重患者中的应用[J].今日健康,2016,15(1):94.
[7] Lao QY,Sun M,Yu L,et al.Lipofibromatosis:a clinicopathological analysis of eight cases[J].NCBI,2018,47(3):186-191.
[8] 胡健卫,周平红,姚礼庆,等.内镜经黏膜下隧道肿瘤切除术治疗直肠固有肌层肿瘤[J].中华胃肠外科杂志,2013,16(12):l155-1158:
[9] 焦春花,杨树平,李学良,等.经黏膜下隧道内镜切除术治疗食管中下段黏膜下肿瘤的初步探索[J].中华医学杂志,2013,93(30):2388-2391.
[9] 张瑞,汤娜娜,陶生,等.ESD对分泌性肿瘤和上皮性肿瘤治疗的临床评价[J].中国中西医结合消化杂志,2017,22(1):48-51.
[10] 徐美东,陆巍,李全林,等.内镜经黏膜下隧道肿瘤切除术在胃固有肌层肿瘤中的应用与评价[J].中华胃肠外科杂志,2012,15(7):671-674.
[11] 姜海行,覃山羽,黄杰安,等.经内镜黏膜下隧道肿瘤切除术治疗上消化道黏膜下肿瘤的应用研究[J].微创医学,2013,8(6):660-664.
[12] 闫晓红,赵亚宁,汪华等.替吉奥与三维适形放射用于消化道恶性肿瘤临床治疗价值研究[J].中国中西医结合消化杂志,2018,26(02):163-166.
[13] 何池义,韩真,李芳芳,等.内镜超声检查在上消化道粘膜下肿瘤微创治疗中的价值研究[J].中华消化内镜杂志,2010,27:134-137.
[14] 王轶.经胃镜保留浆膜层切除上消化道固有肌层起源肿瘤技术初探[J].中华消化内镜杂志,2018,35(1):23-26.
[15] 余小冬,金晓燕.谷氨酰胺营养支持对胃肠道恶性肿瘤恶液质患者血清细胞因子水平的影响[J].中国中西医结合消化杂志,2018,7(4):364-366.
[16] 刘锦涛,余细球,侯华君,等.超声内镜对内镜治疗消化道隆起性病变的指导价值[J].中国内镜杂志,2008,14(3):243-248.