小探头超声内镜联合多层螺旋CT术前预测胃黏膜下肿瘤切除方式的临床价值*

Predictive value of microprobe ultrasound endoscopy combined with spiral CT for resection pattern of gastric submucosal tumor*

摘要:

摘要：目的??探讨小探头超声内镜（MPS）联合多层螺旋CT（MSCT）术前预测胃黏膜下肿瘤（SMT）切除方式的价值。方法?回顾性分析胃SMT临床病理特征、MPS联合MSCT特征及手术方式等资料。结果?共40例胃SMT。其中，男16例，女24例，平均年龄（54.0±14.2）岁。胃底SMT占52.5%，基于MPS及MSCT特征，术前诊断胃腔内生长型37例，胃腔内外生长型2例，腔外生长型1例，除外1例副脾外术后均获得证实，MPS联合MSCT对胃SMT生长方式诊断准确率97.5%（39/40）。MPS提示来源于固有肌层低回声占37例，黏膜下层3例，除外1例副脾外，MPS联合MSCT术前对肿瘤来源层次判断准确率为97.5%（39/40）。MPS诊断间质瘤36例，术后病理证实为间质瘤27例，MPS诊断间质瘤准确率75.0%（27/36）。30例选择内镜切除术，内镜手术成功率96.7%（29/30），1例中转腹腔镜手术，内镜切除瘤体直径0.5～5.0?cm，平均（1.7±1.0）cm。腹腔镜切除11例，成功率100.0%（11/11），瘤体直径2.0～7.5?cm，平均（4.3±1.8）cm。与腹腔镜手术比较，内镜切除瘤体大小明显小于腹腔镜手术（P?<0.05），术后平均住院日明显短于腹腔镜（P?<0.05），两种切除方式术后随访均未见复发。结论?MPS联合MSCT术前诊断SMT肿瘤来源层次、生长方式、诊断准确率高，能够有效指导肿瘤切除方式的选择。

Abstract:

Abstract: Objective?To evaluate the predictive value of microprobe ultrasound (MPS) endoscopy combined with multi spiral CT (MSCT) on resection pattern of gastric submucosal tumors (SMT).?Methods?The clinical pathological characteristics, MPS and MSCT features and resection pattern of the gastric SMT were retrospectively analyzed.?Results?All the 40 patients with gastric SMT were enrolled with 16 male and 24 female. Average age was (54.0?±?14.2). 52.5% located in gastric fundus. Based on the features of MPS and MSCT, 37 cases were internal-gastric growth type, 2 cases were internal and external gastric growth type and 1 case was external gastric growth type, all were confirmed after operation, the diagnostic accuracy of growth type was 100.0%. 37 cases comes from the muscularis propria, the diagnostic accuracy rate of tumor origin was 97.5%. 36 cases were diagnosed as mesenchymal tumors by MPS, the diagnostic accuracy rate of mesenchymal tumors was 75.0% (27/36). 30 cases were performed endoscopic resections, the surgical success rate was 96.7% (29/30), the maximum diameter of tumor was 5 cm and the mean diameter was (1.7?±?1.4)?cm. 11 cases performed laparoscopic resection, the maximum diameter of tumor was 7.5 cm and the mean diameter was (4.3?±?1.8)?cm. Compared with laparoscopic operation, the tumor size was significant smaller than that of laparoscopic surgery, while postoperative average residential day was significantly shorter than laparoscopic surgery. No recurrence was observed during the fellow up after the two resections.?Conclusion?MPS combined with MSCT has high predictive value of tumor origin, growth type and high diagnostic accurate rate of gastric SMT, and can effectively predict surgery pattern.