中华全科医师杂志
中華全科醫師雜誌
중화전과의사잡지
CHINESE JOURNAL OF GENERAL PRACTITIONERS
2014年
6期
452-456
,共5页
王晓凡%谭诗云%李明%杨力%刘迎春%谢文群
王曉凡%譚詩雲%李明%楊力%劉迎春%謝文群
왕효범%담시운%리명%양력%류영춘%사문군
胃肠道间质肿瘤%腔内超声检查%诊断
胃腸道間質腫瘤%腔內超聲檢查%診斷
위장도간질종류%강내초성검사%진단
Gastrointestinal stromal tumor%Endosonography%Diagnosis
目的:探讨术前超声内镜检查对胃间质瘤侵袭危险性的初步判断及治疗方式选择价值。方法对我院2011年1月至2012年1月诊治的135例经超声内镜和/或病理学诊断的胃间质瘤进行回顾性分析,根据术前内镜超声图像相关特点初步判断间质瘤侵袭危险程度,与术后病理检查结果进行Fletcher侵袭危险性对比分析,并对其中38例已行手术治疗的患者的治疗方法选择进行分析。结果135例患者除少数巨大间质瘤顶端出现溃疡合并呕血或黑便外,绝大多数胃间质瘤临床表现缺乏特征性。其中97例患者未行任何治疗选择内镜下动态随访观察;38例患者超声内镜侵袭危险性评分标准发现低度侵袭危险性9例,中度侵袭危险性18例,高度侵袭危险性11例。38例选择不同的手术方式,其中单纯内镜治疗15例,双镜联合治疗17例,开腹手术治疗6例,并同时行病理组织检查,结果发现术前超声内镜与术后病理检查判断胃间质瘤符合率约为79.0%。结论术前应用超声内镜初步判断胃间质瘤的危险性有助于提高术前诊断水平和选择合适的治疗方案。胃镜或胃镜联合腹腔镜为临床治疗胃间质瘤的优先选择。
目的:探討術前超聲內鏡檢查對胃間質瘤侵襲危險性的初步判斷及治療方式選擇價值。方法對我院2011年1月至2012年1月診治的135例經超聲內鏡和/或病理學診斷的胃間質瘤進行迴顧性分析,根據術前內鏡超聲圖像相關特點初步判斷間質瘤侵襲危險程度,與術後病理檢查結果進行Fletcher侵襲危險性對比分析,併對其中38例已行手術治療的患者的治療方法選擇進行分析。結果135例患者除少數巨大間質瘤頂耑齣現潰瘍閤併嘔血或黑便外,絕大多數胃間質瘤臨床錶現缺乏特徵性。其中97例患者未行任何治療選擇內鏡下動態隨訪觀察;38例患者超聲內鏡侵襲危險性評分標準髮現低度侵襲危險性9例,中度侵襲危險性18例,高度侵襲危險性11例。38例選擇不同的手術方式,其中單純內鏡治療15例,雙鏡聯閤治療17例,開腹手術治療6例,併同時行病理組織檢查,結果髮現術前超聲內鏡與術後病理檢查判斷胃間質瘤符閤率約為79.0%。結論術前應用超聲內鏡初步判斷胃間質瘤的危險性有助于提高術前診斷水平和選擇閤適的治療方案。胃鏡或胃鏡聯閤腹腔鏡為臨床治療胃間質瘤的優先選擇。
목적:탐토술전초성내경검사대위간질류침습위험성적초보판단급치료방식선택개치。방법대아원2011년1월지2012년1월진치적135례경초성내경화/혹병이학진단적위간질류진행회고성분석,근거술전내경초성도상상관특점초보판단간질류침습위험정도,여술후병리검사결과진행Fletcher침습위험성대비분석,병대기중38례이행수술치료적환자적치료방법선택진행분석。결과135례환자제소수거대간질류정단출현궤양합병구혈혹흑편외,절대다수위간질류림상표현결핍특정성。기중97례환자미행임하치료선택내경하동태수방관찰;38례환자초성내경침습위험성평분표준발현저도침습위험성9례,중도침습위험성18례,고도침습위험성11례。38례선택불동적수술방식,기중단순내경치료15례,쌍경연합치료17례,개복수술치료6례,병동시행병리조직검사,결과발현술전초성내경여술후병리검사판단위간질류부합솔약위79.0%。결론술전응용초성내경초보판단위간질류적위험성유조우제고술전진단수평화선택합괄적치료방안。위경혹위경연합복강경위림상치료위간질류적우선선택。
Objectives To evaluate the application of preoperative endoscopic ultrasonography ( EUS) in assessment of invasive risk and selection of therapeutic modalities for gastric stromal tumors ( GST).Methods The clinical data of 135 patients with GST admitted in our hospital from January 2011 to January 2012 were retrospectively analyzed.The invasion extent of GST was assessed by image of EUS before surgery, and compared with pathological results after surgery; the Fletcher 4-tier system was used for predicting the aggressiveness of GST.The selection of therapeutic modalities in 38 patients, who underwent surgical treatment was analyzed.Results No specific clinical manifestations were noticed , but some patients with enormous GST had symptoms of ulcer , hematemesis , and melena.Among 135 patients 97 cases received conservative treatment and followed up;in remaining 38 cases, according to invasion risk assessed by EUS, there were 9 cases in low risk, 18 in intermediate risk and 11 in high risk.The surgical modalities were selected based on the risk assessment:endoscopic therapy was performed in 15 cases, laparoscopic with gastroscopic surgery in 17 cases and laparotomy in 6 cases.The coincidence rate of diagnosis between preoperative EUS and postoperative pathological examination was 79.0%.Conclusions Preoperative endoscopic ultrasonography is of value in assessment of invasion risk and selection of appropriate therapeutic modalities for gastric stromal tumors.