超声胃镜在胃间质瘤的诊断及危险度分级中的价值

发布时间：2018-08-29 08:31

【摘要】：目的:回顾性分析超声胃镜在胃间质瘤诊断中的价值,探讨胃间质瘤的潜在恶性危险度分级与年龄、性别、部位、内部回声情况及最大直径的相关性,提高超声胃镜对胃间质瘤危险度的评估,为患者的下一步临床治疗提供依据。方法:选取青岛大学附属医院2015年6月-2016年10月期间超声胃镜下拟诊为胃间质瘤的病例共71例,病变均行手术切除治疗,术后病理确诊胃间质瘤共46例,回顾性分析确诊为胃间质瘤的46例患者的临床资料,根据病理结果,按照2001年美国国立卫生研究院制定的GIST危险度分级标准将其分为高危组、中危组、低危组及极低危组四组,因胃间质瘤的极低危组与低危组两组在临床生物学行为方面表现相近,且超声胃镜镜下表现不易区分,故将其视为一组,以低危组表示,故本组究共分为三组,即高危组、中危组、低危组。通过统计学方法比较胃间质瘤危险度分级与患者年龄、性别、肿瘤生长部位、内部回声情况及最大直径等单一变量之间的关系。结果:EUS诊断胃间质瘤的准确率为64.79%,病理确诊的46例胃间质瘤患者中,男女比例为1.09:1,年龄介于20-81岁,平均年龄57.9岁,临床表现多样,无症状者共22例,占47.8%,有症状者共24例,其中不明原因的腹痛、腹胀、早饱者共20例,占43.5%,出现黑便者共4例,占8.7%,腹部触及肿块者1例,占2.2%。根据胃间质瘤的危险度分级标准对46例病例进行分组,其中高危组共5例,中危组共9例,低危组共32例,由统计学分析得出,年龄、性别均与肿瘤的危险度分级无关(P0.05);根据胃间质瘤的生长部位分为胃底、胃体、胃窦组三组,其中病变位于胃底、胃体、胃窦部的分别为30例、12例、4例,各占65.22%、26.09%、8.69%,从数据中可看出,胃间质瘤在胃底、胃体部的发病率较高;46例位于胃底部者低危组、中危组、高危组各21例、6例、3例;胃体部病变其低危组、中危组、高危组各8例、2例、2例;胃窦部病变其低危组、中危组、高危组各3例、1例、0例,由统计学分析得出,肿瘤的不同生长部位与其危险度分级无关(P0.05);根据超声胃镜下的肿瘤内部回声情况,将其分为回声均匀组与不均匀组,高危组回声均匀组0例,不均匀组5例,中危组回声均匀组1例,不均匀组8例,低危组回声均匀组13例,不均匀组19例,由统计学分析得出,肿瘤内部回声越不均匀,危险度分级越高(P0.05);超声胃镜下胃间质瘤最大径介于0.6-11.0cm,低危组直径介于0.6-3.5cm,平均直径为2.00cm;中危组直径介于1.5-5.5cm,平均直径为3.41cm;高危组直径介于5.0-11.0cm,平均直径7.22cm。通过统计学分析最终得出,肿瘤的直径越大,危险度分级就越高(P0.05)。结论:超声胃镜是诊断胃间质瘤最主要的方法,其准确率为64.79%,有较高的诊断价值;胃间质瘤在胃底、胃体部的发病率高于胃窦部;本组研究显示胃间质瘤危险度分级与患者年龄、性别、肿瘤生长部位无关,与病灶大小及内部回声相关。
[Abstract]:Objective: to retrospectively analyze the value of ultrasound gastroscopy in the diagnosis of gastric stromal tumors (GIST), and to explore the correlation between the classification of potential malignant risk and age, sex, location, internal echo and maximum diameter of gastric stromal tumors (GIST). To improve the risk assessment of gastric stromal tumors by ultrasound gastroscopy, and to provide the basis for the next clinical treatment of patients. Methods: a total of 71 cases of gastric stromal tumors (GIST) were selected from the affiliated Hospital of Qingdao University from June 2015 to October 2016. The lesions were surgically resected and 46 cases were confirmed by pathology after operation. The clinical data of 46 patients with gastric stromal tumors (GIST) were retrospectively analyzed. According to the pathological results, the patients were divided into high risk group, middle risk group, low risk group and very low risk group according to the GIST risk classification standard established by the National Institutes of Health in 2001. Because the very low risk group of gastric stromal tumor and the low risk group have similar clinical biological behavior, and it is difficult to distinguish them under ultrasound gastroscopy, they are regarded as one group, expressed as low risk group, so this group is divided into three groups: high risk group. Moderate risk group, low risk group. The relationship between the risk grade of gastric stromal tumor and single variables such as age, sex, tumor growth site, internal echo and maximum diameter was compared by statistical method. Results the accuracy rate of diagnosis of gastric stromal tumors was 64.79. The ratio of male to female was 1.09: 1 in 46 cases of gastric stromal tumors diagnosed by pathology. The average age was 57.9 years old. The average age was 57.9 years. There were 22 asymptomatic cases (47.8%) and 24 cases with symptoms. There were 20 cases (43.5%) with abdominal pain, abdominal distension and early satiety, 4 cases (8.7%) with black stool, 1 case (2.2%) with abdominal touching mass. According to the risk classification criteria of gastric stromal tumors, 46 cases were divided into high risk group (n = 5), middle risk group (n = 9) and low risk group (n = 32). According to the growth site of gastric stromal tumors, they were divided into three groups: gastric fundus, gastric body and antrum. The pathological changes in gastric fundus, gastric body and antrum were 30 cases, gastric body, and antrum respectively in 30 cases, 12 cases (4 cases), accounting for 65.220.26.09% (8.69%) respectively, as can be seen from the data. The incidence of gastric stromal tumors (GIST) in the fundus and body of stomach was higher in 46 patients with lower risk of gastric fundus, in the middle risk group, in the high risk group, 21 cases in the high risk group, 6 cases in the high risk group, 2 cases in the low risk group, 2 cases in the middle risk group, 8 cases in the high risk group, 2 cases in the low risk group and 2 cases in the high risk group, respectively. The low risk group, middle risk group and high risk group of gastric antral lesions had 1 case or 0 cases each. According to the statistical analysis, the different growth sites of the tumor were not related to its risk grade (P0.05); according to the echo of the tumor under the ultrasound gastroscopy, the tumor had no correlation with the risk grade (P0.05). They were divided into two groups: homogeneous echo group (n = 0), heterogeneous group (n = 5), moderate risk group (n = 1), heterogeneous group (n = 8), low risk group (n = 13) and heterogeneous group (n = 19). According to statistical analysis, the more uneven the echo inside the tumor, The maximum diameter of gastric stromal tumor was 0.6-11.0 cm under ultrasound gastroscopy, the diameter of low-risk group was 0.6-3.5 cm, the average diameter was 2.00 cm, the diameter of medium-risk group was 1.5-5.5 cm, the average diameter was 3.41 cm, and the diameter of high-risk group was 5.0-11.0 cm, the average diameter was 7.22 cm. Through statistical analysis, the larger the tumor diameter, the higher the risk grade (P0.05). Conclusion: ultrasonic gastroscopy is the most important method in the diagnosis of gastric stromal tumors, and its accuracy is 64.79, which has higher diagnostic value, and the incidence of gastric stromal tumors in the fundus and body of stomach is higher than that in antrum. The risk classification of gastric stromal tumors was not related to age, sex, tumor growth site, but to the size of the lesion and internal echo.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.2

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