临床荟萃
臨床薈萃
림상회췌
CLINICAL FOCUS
2014年
5期
490-493
,共4页
王江%俞清翔%何占坤%郑忠青%王涛%王邦茂
王江%俞清翔%何佔坤%鄭忠青%王濤%王邦茂
왕강%유청상%하점곤%정충청%왕도%왕방무
食管肿瘤%胃肿瘤%胃镜检查
食管腫瘤%胃腫瘤%胃鏡檢查
식관종류%위종류%위경검사
esophageal neoplasms%stomach neoplasms%gastroscopy
目的：探讨食管间质瘤和胃间质瘤的临床特点及内镜下治疗。方法回顾性分析经本院内镜治疗的30例食管间质瘤和146例胃间质瘤的临床资料。分析患者的基本情况、病变部位及起源、免疫组织化学特征、治疗情况以及术后随访结果。结果食管间质瘤30例,男22例,女8例。病变多位于食管下段,63.3%病变起源于固有肌层。胃间质瘤146例,男41例,女105例。病变多位于胃底部,98.0%病变起源于固有肌层。免疫组织化学检查示食管间质瘤 CD117,CD34,SMA,desmin 阳性率分别为93.3%,93.3%,73.3%,73.3%；胃间质瘤 CD117,CD34,SMA,desmin阳性率分别为94.5%,88.4%,21.9%,19.2%。22例食管间质瘤行内镜黏膜下剥离术(ESD),8例行内镜黏膜下隧道肿瘤切除术(STER),病灶均一次性完整切除,1例患者 ESD 术中发生穿孔。145例胃间质瘤行 ESD,1例行内镜下氩离子凝固术(APC),一次性完整切除率95.2%,术中穿孔39例,出血1例。所有穿孔及出血患者均经内镜下修复。术后随访3~50个月未发现肿瘤残留和复发。结论胃肠道间质瘤缺乏特异性临床表现,但食管间质瘤和胃间质瘤在肿瘤位置分布和起源、免疫组织化学方面各具特点,内镜下微创技术已发展为治疗胃肠道间质瘤新的手段之一。
目的：探討食管間質瘤和胃間質瘤的臨床特點及內鏡下治療。方法迴顧性分析經本院內鏡治療的30例食管間質瘤和146例胃間質瘤的臨床資料。分析患者的基本情況、病變部位及起源、免疫組織化學特徵、治療情況以及術後隨訪結果。結果食管間質瘤30例,男22例,女8例。病變多位于食管下段,63.3%病變起源于固有肌層。胃間質瘤146例,男41例,女105例。病變多位于胃底部,98.0%病變起源于固有肌層。免疫組織化學檢查示食管間質瘤 CD117,CD34,SMA,desmin 暘性率分彆為93.3%,93.3%,73.3%,73.3%；胃間質瘤 CD117,CD34,SMA,desmin暘性率分彆為94.5%,88.4%,21.9%,19.2%。22例食管間質瘤行內鏡黏膜下剝離術(ESD),8例行內鏡黏膜下隧道腫瘤切除術(STER),病竈均一次性完整切除,1例患者 ESD 術中髮生穿孔。145例胃間質瘤行 ESD,1例行內鏡下氬離子凝固術(APC),一次性完整切除率95.2%,術中穿孔39例,齣血1例。所有穿孔及齣血患者均經內鏡下脩複。術後隨訪3~50箇月未髮現腫瘤殘留和複髮。結論胃腸道間質瘤缺乏特異性臨床錶現,但食管間質瘤和胃間質瘤在腫瘤位置分佈和起源、免疫組織化學方麵各具特點,內鏡下微創技術已髮展為治療胃腸道間質瘤新的手段之一。
목적：탐토식관간질류화위간질류적림상특점급내경하치료。방법회고성분석경본원내경치료적30례식관간질류화146례위간질류적림상자료。분석환자적기본정황、병변부위급기원、면역조직화학특정、치료정황이급술후수방결과。결과식관간질류30례,남22례,녀8례。병변다위우식관하단,63.3%병변기원우고유기층。위간질류146례,남41례,녀105례。병변다위우위저부,98.0%병변기원우고유기층。면역조직화학검사시식관간질류 CD117,CD34,SMA,desmin 양성솔분별위93.3%,93.3%,73.3%,73.3%；위간질류 CD117,CD34,SMA,desmin양성솔분별위94.5%,88.4%,21.9%,19.2%。22례식관간질류행내경점막하박리술(ESD),8례행내경점막하수도종류절제술(STER),병조균일차성완정절제,1례환자 ESD 술중발생천공。145례위간질류행 ESD,1례행내경하아리자응고술(APC),일차성완정절제솔95.2%,술중천공39례,출혈1례。소유천공급출혈환자균경내경하수복。술후수방3~50개월미발현종류잔류화복발。결론위장도간질류결핍특이성림상표현,단식관간질류화위간질류재종류위치분포화기원、면역조직화학방면각구특점,내경하미창기술이발전위치료위장도간질류신적수단지일。
Objective The study aimed to investigate the clinical characteristics and treatment of gastrointestinal stromal tumor between esophagus and stomach under endoscope.Methods A total of 30 patients with esophageal stromal tumors and 146 patients with gastric stromal tumors which experienced endoscopic surgery were enrolled.The demographic information,disease location and origination,immunohistochemistry features,treatment and follow-up outcome were analyzed.Results Among 30 patients with esophageal stromal tumors,22 were males and 8 were females.The lesions mainly located in the lower thirds of the esophagus and 63.3% of the lesions originated from the muscularis propria.Of 146 patients with gastric stromal tumors,41 were males and 105 were females.Most of the lesions located in fundus and 98.0% of the lesions arose from the muscularis propria.Positive rate of CD1 1 7,CD34, SMA and desmin in esophageal stromal tumors were 93.3%,93.3%,73.3% and 73.3%,respectively.Positive rate of CD1 1 7,CD34,SMA and desmin in gastric stromal tumors were 94.5%,88.4%,21.9% and 1 9.2%,respectively.22 patients and 8 patients with esophageal stromal tumors received endoscopic submucosal dissection (ESD ) and submucosal tunneling endoscopic resection(STER),and all tumors were removed completely.Perforation occurred in one patient in procedure of ESD.145 patients and 1 patient with gastric stromal tumors underwent ESD and argon plasma coagulation (APC ),respectively.The one-time complete resection rate was 95.2%.Perforation and intraoperative bleeding occurred in 39 patients and 1 patient,respectively.All patients with perforation and intraoperative bleeding were successfully repaired by endoscopic measures.Patients were followed up for 3 to 50 months,and no residue or recurrence of tumor was detected.Conclusion Gastrointestinal stromal tumor has no special clinical manifestation.However,esophageal stromal tumor and gastric stromal tumor have their own feature in tumor location, origination and immunohistochemical features.Minimally invasive surgery under endoscope proved to be a new choice for treating gastrointestinal stromal tumor.
