| Objective: Evaluate the feasibility of endoscopic treatment of small gastric stromal tumors,and discuss the advantages and disadvantages of endoscopic treatment of small gastric stromal tumors and laparoscopic treatment to provide guidance for future clinical work.Methods: A retrospective analysis of 72 patients with small gastric stromal tumors treated with laparoscopy and endoscopic therapy at the Bethune First Hospital of Jilin University from January 2013 to December 2017 was performed.All were pathological and immunohistochemical examination confirmed.Results: 1.General information: A total of 72 cases were included in the study,including 28 male patients and 44 female patients.The male to female ratio was 0.64:1.The average age is 57.51±10.21 years old,the maximum age is 75 years old,and the minimum age is 35 years old,mainly middle age and old age.Fifty-six patients admitted to hospital for abdominal pain,bloating,abdominal discomfort,nausea,vomiting and other non-specific symptoms were admitted to the hospital on routine physical examination.There were no patients admitted to hospital because of gastrointestinal bleeding and abdominal masses.All72 patients had a single site disease.The largest tumor diameter was less than 2 cm and the average size was 1.35±0.46 cm.The tumors were located in the fundus and cardia in 48 cases,19 cases in the stomach body,and 5 cases in the gastric antrum.Ultrasound endoscopy preoperative diagnosis of gastric stromal tumors in 60 cases,10 cases misdiagnosed as gastric leiomyoma,2 cases misdiagnosed as gastric ectopic pancreas,its effective detection rate 83.3%.Abdominal CT plain scan and enhanced preoperative diagnosis of gastric stromal tumors in 48 cases,22 cases only showed a slight thickening of the gastric wall lesions,2 cases found no abnormalities,the effective detection rate 66.7 %.Resection specimens were sent to pathology and immunohistochemistry: 72 CD117(+),71 CD34(+),70 dog-1(+).Seventy-one patients with microscopic mitoses less than 5/50 HPF were in the extremely low risk group.Only 1 case had a mitose greater than 5/50 HPF,which was a moderate risk group.Of the 72 patients in the study,27 underwent endoscopic treatment in our hospital,17 underwent ESD,and 10 underwent EFR.All tumors were successfullyresected once and all were R0 resections with negative margins.There was no acute massive bleeding in the patient.One patient in the ESD group had acute bleeding and given electrocoagulation to stop bleeding.In the EFR group,there was one case of subcutaneous emphysema and pneumoperitoneum,which was relieved after abdominal paracentesis,and subcutaneous emphysema disappeared after conservative treatment.In the same period,45 cases of gastric stromal tumors were removed by laparoscopy in our hospital.All of them were successfully resected.No laparotomy was performed until laparotomy.One case had abdominal infection after operation and 2 cases had postoperative low fever.All patients were followed up after operation.Gastroscopes were performed at the 3rd or 6th months after operation.The results showed that the surgical incision healed well and no tumor recurrence was found.2.Comparing the data of the endoscopic group with the laparoscopic group,endoscopic excision of small gastric stromal tumors was associated with shortened operative time and reduced hospital costs compared with laparoscopy(P<0.05).There was no significant difference in gender,age,clinical complaints,tumor site,cure rate,recurrence rate,and incidence of complications(P>0.05).Endoscopic resection of small gastric stromal tumors is safe,effective and feasible.Conclusions:(1)Small gastric stromal tumors are mainly middle-aged and elderly,and their clinical manifestations have no obvious specificity..In preoperative diagnosis,EUS is superior to enhanced CT.(2)Endoscopic resection of small gastric stromal tumors is safe,effective and feasible.(3)Endoscopic resection of small gastric stromal tumors has the same effect as laparoscopy,but it can reduce operative time and hospital costs.For small gastric stromal tumors,endoscopic treatment can completely replace laparoscopic treatment. |
PDF Full Text Request