Department of Gastroenterology, Yantai Yu Huang Ding Hospital, Yantai 264000, Shandong Province, China.
World J Gastroenterol. 2012 Jul 14;18(26):3465-71. doi: 10.3748/wjg.v18.i26.3465.
To explore endoscopic therapy methods for gastric stromal tumors originating from the muscularis propria.
For 69 cases diagnosed as gastric stromal tumors originating from the muscularis propria, three types of endoscopic therapy were selected, based on the size of the tumor. These methods included endoscopic ligation and resection (ELR), endoscopic submucosal excavation (ESE) and endoscopic full-thickness resection (EFR). The wound surface and the perforation of the gastric wall were closed with metal clips. Immunohistostaining for CD34, CD117, Dog-1, S-100 and smooth muscle actin (SMA) was performed on the resected tumors.
A total of 38 cases in which the tumor size was less than 1.2 cm were treated with ELR; three cases were complicated by perforation, and the perforations were closed with metal clips. Additionally, 18 cases in which the tumor size was more than 1.5 cm were treated with ESE, and no perforation occurred. Finally, 13 cases in which the tumor size was more than 2.0 cm were treated with EFR; all of the cases were complicated by artificial perforation, and all of the perforations were closed with metal clips. All of the 69 cases recovered with medical treatment, and none required surgical operation. Immunohistostaining demonstrated that among all of the 69 gastric stromal tumors diagnosed by gastroscopy, 12 cases were gastric leiomyomas (SMA-positive), and the other 57 cases were gastric stromal tumors.
Gastric stromal tumors originating from the muscularis propria can be treated successfully with endoscopic techniques, which could replace certain surgical operations and should be considered for further application.
探讨固有肌层来源的胃间质瘤的内镜治疗方法。
对 69 例固有肌层来源的胃间质瘤患者，根据肿瘤大小选择内镜套扎切除术（ELR）、内镜黏膜下挖除术（ESE）和内镜全层切除术（EFR）等 3 种内镜治疗方法。胃壁创面及穿孔均用金属夹封闭。对切除标本行 CD34、CD117、Dog-1、S-100 和平滑肌肌动蛋白（SMA）免疫组化染色。
肿瘤直径＜1.2 cm 的 38 例患者行 ELR 治疗，其中 3 例发生穿孔，均用金属夹封闭；肿瘤直径＞1.5 cm 的 18 例行 ESE 治疗，均未发生穿孔；肿瘤直径＞2.0 cm 的 13 例行 EFR 治疗，均发生人工穿孔，均用金属夹封闭。69 例患者均经内科治疗痊愈，无需外科手术。免疫组化染色显示：69 例经胃镜诊断为胃间质瘤的患者中，胃平滑肌瘤 12 例（SMA 阳性），胃间质瘤 57 例。
固有肌层来源的胃间质瘤可以通过内镜技术成功治疗，可替代部分外科手术，值得进一步应用。
