上消化道黏膜下病变临床病理特征分析

发布时间：2018-05-08 16:01

本文选题：上消化道黏膜下病变 + 超声内镜　；参考：《蚌埠医学院》2017年硕士论文

【摘要】：目的:随着常规胃镜的普及及超声内镜技术的发展,上消化道黏膜下病变(Upper gastrointestinal submucosal lesions,SML)的检出率不断提高,不同病理类型的SML的治疗原则及预后不尽相同。本文主要通过研究不同部位SML的好发年龄、病变来源层次、常见病理类型的差异,以提高临床的SML的诊断水平。方法:回顾性分析我院2015年1月至2016年12月经超声内镜及术后病理确诊为SML的295例患者的临床资料,观察SML常规胃镜下表现,收集超声胃镜下不同部位SML的大小、回声特点、来源层次等特征,及术后病理结果。分析不同部位的性别构成比、年龄构成比、来源层次构成比、病理类型构成之间的统计学差异,及间质瘤与平滑肌瘤的免疫组化结果的差异。结果:295例患者中位于食管者139例、贲门17例、胃底34例、胃体32例、胃窦59例、十二指肠14例,男女比例为1:1.35,平均年龄51.3±10.9岁,病变平均直径为9.36±4.47mm,SML好发于食管(47.1%)及胃部(48.1%),胃部以胃窦部(20%)常见,不同部位SML的年龄构成比、起源层次构成比、病理类型构成比不同,差异均有统计学意义(P0.05);不同部位SML肿物大小不同,差异有统计学意义(P0.05),食管及十二指肠病变相对于其他部位偏小。不同部位SML患者性别构成比,差异无统计学意义(P0.05)。平滑肌瘤、异位胰腺、间质瘤、脂肪瘤超声内镜下表现不同。平滑肌瘤中SMA阳性率为98.5%,间质瘤中CD117阳性率为85.7%,CD34为78.5%、DOG-1为78.5%。结论:不同部位SML的好发年龄、常见表现、病变起源层次、病理类型不尽相同,超声内镜是诊断上消化道SML的有效方法,异位胰腺及脂肪瘤好发于黏膜下层,平滑肌瘤好发于黏膜肌层,间质瘤好发于固有肌层。CD117、CD34、DOG-1、SMA是平滑肌瘤与间质瘤鉴别的重要免疫标记物。
[Abstract]:Objective: with the popularization of conventional gastroscopy and the development of endoscopic ultrasonography, the detection rate of upper gastrointestinal submucosal lesions in upper gastrointestinal tract submucosal lesions is increasing, and the treatment principles and prognosis of different pathological types of SML are different. In order to improve the diagnostic level of SML, the authors studied the differences of the predilection age, pathological origin and common pathological types of SML in different sites. Methods: the clinical data of 295 patients with SML diagnosed by endoscopic ultrasonography and postoperative pathology from January 2015 to December 2016 in our hospital were analyzed retrospectively. The features of SML in different parts of SML were collected. Source level and other features, and postoperative pathological results. The differences of sex ratio, age ratio, origin level ratio, pathological type composition and immunohistochemical results between stromal tumors and leiomyomas were analyzed. Results among the 295 patients, 139 were located in esophagus, 17 in cardia, 34 in fundus, 32 in body, 59 in antrum and 14 in duodenum. The ratio of male to female was 1: 1.35 with an average age of 51.3 卤10.9 years. The mean diameter of the lesion was 9.36 卤4.47mmSML, which occurred in the esophagus (47.1) and the stomach (48.1g). The gastric antrum was 20%). The age composition ratio, the origin level ratio and the pathological type ratio of SML in different parts were different. The difference was statistically significant (P 0.05), the size of SML tumor was different in different parts, the difference was statistically significant (P 0.05), and the esophageal and duodenal lesions were smaller than those in other parts. There was no significant difference in sex composition ratio of SML patients in different sites (P 0.05). Leiomyoma, ectopic pancreas, stromal tumor and lipoma show different endoscopic findings. The positive rate of SMA in leiomyoma was 98.5 and the positive rate of CD117 in stromal tumor was 85.7and CD34 was 78.5 and DOG-1 was 78.5. Conclusion: the predilection age, common manifestation, origin and pathological type of SML in different sites are different. EUS is an effective method for the diagnosis of SML in upper digestive tract. Ectopic pancreas and lipoma usually occur in submucosa. Leiomyoma usually occurs in the myometrium of mucous membrane and stromal tumors in the myometrium propria. CD117 and CD34-DOG-1 SMA are important immunomarkers for differentiating leiomyoma from stromal tumor.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R57

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