术前超声内镜检查对胃间质瘤危险性判断及治疗方式选择分析

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。

Endoscopic ultrasonography in assessment of invasive risk and selection of therapeutic modalities for gastric stromal tumor

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.