内镜黏膜下剥离术治疗食管和胃的大胃肠道间质瘤。
Endoscopic submucosal dissection of large gastrointestinal stromal tumors in the esophagus and stomach.
机构信息
Department of Digestive Diseases, General Hospital, Tianjin Medical University, Tianjin, China.
出版信息
J Gastroenterol Hepatol. 2013 Feb;28(2):262-7. doi: 10.1111/jgh.12056.
BACKGROUND AND AIM
Gastrointestinal stromal tumors (GISTs), the most common mesenchymal tumors of the digestive tract with potential for malignant transformation, are mainly treated by open surgery or laparoscopic resection. The aim of this retrospective study was to evaluate the clinical efficacy, safety, and feasibility of endoscopic submucosal dissection (ESD) for large-size (2-5 cm) GISTs in the esophagus and stomach.
METHODS
A total of 31 patients with large-size GISTs in the esophagus (6 patients) and stomach (25 patients) underwent ESD between September 2008 and December 2011. Demographics, clinical data, therapeutic outcomes, complications, pathological characteristics, risk classification, and follow-up outcomes were recorded.
RESULTS
ESD was successfully performed in 31 patients at age of 59.06 ± 7.23 years (range: 46-74). The mean time of the procedure was 70.16 ± 16.25 min (range: 40-105). Perforation for 2-10 mm occurred in six patients (19.35%) and was endoscopically repaired with clips or nylon bands, with no conversions to open surgery. Intraoperative bleeding occurred in three patients (9.68%) and was corrected with argon plasma coagulation or hot biopsy forceps. No mortalities occurred. The mean size of the resected tumors was 2.70 ± 0.72 cm (range: 2.0-5.0). Out of the 31 patients, 24 (77.42%) were at very low risk and 7 (22.58%) were at low risk. Positive rate of CD117, DOG-1, and CD34 were 83.87%, 12.90%, and 100%, respectively. A follow up for 14.29 ± 8.99 months (range: 3-39) showed no recurrence or metastasis.
CONCLUSIONS
ESD appears to be an effective, safe, and feasible treatment for large-size GISTs in the esophagus and stomach.
背景与目的
胃肠道间质瘤（GISTs）是消化道最常见的具有恶性转化潜能的间叶源性肿瘤，主要采用开放手术或腹腔镜切除治疗。本回顾性研究旨在评估内镜黏膜下剥离术（ESD）治疗食管和胃大尺寸（2-5cm）GIST 的临床疗效、安全性和可行性。
方法
2008 年 9 月至 2011 年 12 月，31 例食管（6 例）和胃（25 例）大尺寸 GIST 患者接受了 ESD。记录患者的人口统计学、临床资料、治疗结果、并发症、病理特征、风险分类和随访结果。
结果
31 例患者年龄为 59.06±7.23 岁（范围：46-74 岁），ESD 均成功完成。手术时间平均为 70.16±16.25min（范围：40-105min）。6 例（19.35%）患者发生 2-10mm 的穿孔，采用夹闭或尼龙带进行内镜下修复，无中转开腹手术。3 例（9.68%）患者术中出血，采用氩等离子凝固或热活检钳纠正。无死亡病例。切除肿瘤的平均大小为 2.70±0.72cm（范围：2.0-5.0cm）。31 例患者中，24 例（77.42%）为极低危，7 例（22.58%）为低危。CD117、DOG-1 和 CD34 的阳性率分别为 83.87%、12.90%和 100%。14.29±8.99 个月（范围：3-39 个月）的随访未见复发或转移。
结论
ESD 似乎是一种有效、安全、可行的食管和胃大尺寸 GIST 治疗方法。
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