中国一家大型三级中心 7 年的经验：内镜切除治疗源于固有肌层的胃胃肠间质瘤的临床结果。
Clinical outcomes of endoscopic resection for the treatment of gastric gastrointestinal stromal tumors originating from the muscularis propria: a 7-year experience from a large tertiary center in China.
机构信息
Department of Gastroenterology and Hepatology, The First Medical Center of Chinese PLA General Hospital, Haidian District, No. 28 of Fuxing Road, Beijing, 100853, China.
出版信息
Surg Endosc. 2022 Feb;36(2):1544-1553. doi: 10.1007/s00464-021-08443-9. Epub 2021 Mar 19.
BACKGROUND AND AIMS
Few studies have evaluated the value of endoscopic resection (ER) for the treatment of gastric gastrointestinal (GI) stromal tumors (GISTs) originating from the muscularis propria (MP) in a large population, and no studies have evaluated risk factors for piecemeal resection. This study aimed to evaluate the efficacy and safety of ER for gastric GISTs in a real-world setting and to explore factors associated with piecemeal resection.
METHODS
From January 2013 to December 2019, 185 patients with gastric GISTs originating from the MP were assessed. Clinicopathological and endoscopic data were collected and analyzed. Baseline characteristics of the en bloc resection and piecemeal resection groups were compared to evaluate predictive factors for piecemeal resection.
RESULTS
There were 71 males and 114 females with a mean age of 57.0 ± 9.7 years. The mean size of GISTs was 15 mm (range 4-65 mm). A total of 123 were very low risk, 52 were low risk, and ten were moderate risk. In this study, 103 GISTs were treated with endoscopic submucosal excavation (ESE), 68 GISTs were treated with endoscopic full-thickness resection (EFR), and 14 GISTs were treated with submucosal tunneling ER (STER). Either en bloc resection or complete resection was achieved in 160 (86.5%) patients. No recurrence was noted during follow-up. Only five patients experienced minor complications, with a complication rate of 2.7%. Multivariate analysis demonstrated that size (odds ratio [OR] 1.060, 95% confidence interval [CI] 1.004-1.118; P = 0.035) and shape (OR 5.434, 95% CI 1.638-18.027; P = 0.006) were independent predictors of piecemeal resection.
CONCLUSION
ER was effective and safe for the treatment of gastric GISTs originating from the MP. Piecemeal resection did not seem to affect the efficacy of ER, and no recurrence was noted during follow-up. Large size and irregular shape are risk factors related to piecemeal resection of ER.
背景与目的
很少有研究在大样本人群中评估内镜下切除（ER）治疗源于固有肌层的胃胃肠道间质瘤（GIST）的价值，也没有研究评估分片切除的危险因素。本研究旨在评估真实环境中 ER 治疗胃 GIST 的疗效和安全性，并探讨与分片切除相关的因素。
方法
从 2013 年 1 月至 2019 年 12 月，评估了 185 例源于固有肌层的胃 GIST 患者。收集并分析了临床病理和内镜数据。比较整块切除和分片切除组的基线特征，以评估分片切除的预测因素。
结果
患者中男性 71 例，女性 114 例，平均年龄 57.0±9.7 岁。GIST 平均大小为 15mm（范围 4-65mm）。其中极低危 123 例，低危 52 例，中危 10 例。本研究中，103 例 GIST 采用内镜黏膜下挖除术（ESE）治疗，68 例 GIST 采用内镜全层切除术（EFR）治疗，14 例 GIST 采用黏膜下隧道内镜切除术（STER）治疗。整块或完全切除在 160 例（86.5%）患者中实现。随访期间无复发。仅 5 例患者出现轻微并发症，并发症发生率为 2.7%。多因素分析显示，大小（比值比 [OR] 1.060，95%置信区间 [CI] 1.004-1.118；P=0.035）和形状（OR 5.434，95%CI 1.638-18.027；P=0.006）是分片切除的独立预测因素。
结论
ER 治疗源于固有肌层的胃 GIST 是有效且安全的。分片切除似乎不会影响 ER 的疗效，随访期间无复发。大尺寸和不规则形状是与 ER 分片切除相关的危险因素。
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