| Background: Gastrointestinal stromal tumor(Gastrointestinal stromal, tumors, GIST) is a kind of tissue mesenchymal tumors. It originated from gastrointestinal mesenchymal stem cells Cajal cells, gastrointestinal stromal tumor can occur in all organs of the digestive tract, found in the stomach and small intestine. Most of the GIST has a potential risk of malignancy, most expansive growth, rather than invasive growth; rarely invaded neighboring tube, lymphatic invasion is rare, so adequate local excision. GIST is not sensitive to chemotherapy, surgery is still the main means. GIST has open resection to avoid the disadvantages, such as incision pain, incision infection rate is high, edge splitting serious complications such as incision hernia. The endoscopic treatment of GIST with small trauma, quick recovery body, has the advantages of short hospitalization time. GIST lymphatic invasion is rare, so do not advocate systematic lymphadenectomy; the biological characteristics of GIST make it very suitable for endoscopic treatment. At present, with the increasing of treatment of gastrointestinal stromal tumor, endoscopic gastrointestinal stromal tumors reported in the literature gradually increased, but compared with open surgery treatment of GIST are still very rare.Objective: To investigate the clinical features of GIST, improve the gastrointestinal stromal tumor early diagnosis and treatment, to prevent misdiagnosis and missed diagnosis occurred. Comparison of endoscopic resection of gastrointestinal stromal tumors and laparoscopic resection of gastrointestinal stromal tumors of two kinds of operation way of curative effect in the near future, summarize the experience of gastrointestinal stromal tumor resection under endoscope.Methods: 2010 January to 2013 January in Shangdong Province-owned Hospital surgery, endoscopic resection of the tumor was confirmed by pathology in 185 cases of gastrointestinal stromal tumor patients, including 80 cases of patients with endoscopic treatment, 105 cases of surgery. A retrospective analysis of patients with clinical symptoms and signs, laboratory examination, endoscopy, imaging, histopathological and immunohistochemical study, comparison of operative time, endoscopic group and laparotomy group after the gastrointestinal function recovery time, postoperative hospitalization time, postoperative complications, postoperative recurrence, mortality and hospitalization expenses.Results:1. General materials: endoscopic treatment group of 80 cases, 105 cases of open operation group. Endoscopic treatment of male to female ratio was 11:9, the open operation group 11:10, no significant difference between two groups(P > 0.05). The average age was 54.6±3.5 Endoscopy Group(range: 25- 71 years old), open operation group is 55.9±2.9(range: 20 ~ 85 years old), no statistical difference between the two groups(P > 0.05). The symptoms of the endoscopic treatment group for 17 cases of abdominal distention, abdominal pain, 21 cases of upper gastrointestinal bleeding in 23 cases, bowel habits change in 5 cases, 2 cases of dysphagia, physical examination found 9 cases, other 3 cases complained of; 19 cases, open operation group and 35 cases withabdominal distension, abdominal pain, physical examination found 12 cases of upper digestive tract out of 25 cases of blood, bowel habits change in 5 cases, 4 cases of dysphagia, 5 cases with other two groups, the clinical symptoms and signs of no significant difference(P > 0.05).2. Laboratory examination: Endoscopy Group of 80 patients in stool occult blood were positive in 22 cases, 3 cases of CEA, CA125 increased slightly, liver function showed 21 cases of albumin, total protein decreased slightly, hemoglobin decreased in 34 cases; 105 cases in the conventional laparotomy group fecal occult blood were positive in 35 cases, 5 cases of mild CEA, CA125 elevated liver function, albumin, total protein indicated slightly decreased in 30 cases, hemoglobin decreased in 51 cases. The two groups had no significant difference(P > 0.05).3. Endoscopy and imaging: endoscopic group gastroscopy in 63 cases, the positive rate was 65.1%; colonoscopy in 18 cases, the positive rate was 33.3%, abdominal and pelvic CT examination in 54 cases, the positive rate was 85.2%; abdominal B ultrasound examination in 58 cases, the positive rate was 72.4%; 15 cases of gastrointestinal barium meal examination, the positive rate was 53.3%; 9 cases of ultrasound endoscopic examination, the positive rate was 100%; control group of 87 cases of gastroscopy, colonoscopy, the positive rate was 72.4%; 17 cases, the positive rate was 29.4%; abdominal and pelvic CT examination in 75 cases, the positive rate was 86.7%; 78 cases of abdominal B ultrasound examination, the positive rate was 76.9%, gastrointestinal barium meal examination in 21 cases, the positive rate was 57.1%, endoscopic ultrasonography all of the 12 cases were positive, the diagnosis coincidence rate was 100%.4. Pathology and immunohistochemistry: The tumor size was 2.4 1.3cm(1.0-5.0) and 4.3 2.6cm(1.0-10.0) in the open group, and the two groups were statistically significant(P < 0.05). The locations of the tumors(endoscopic group: 12 cases of esophageal, 49 cases of stomach and colon(n = 9), rectum(n = 10) and other cases; laparotomy group: 4 cases of esophagus, 69 cases of stomach, colon in 5 cases, rectum in 2 cases, 22 cases in small intestine, the other 2 cases). Tumors: endoscopic group is extremely low risk in 49 cases, 20 cases of low-risk, intermediate risk in 11 cases, 0 cases of high risk; laparotomy group very low risk of 56 cases, 28 patients with low-risk, intermediate risk in 13 cases, high risk in 8 cases. There was no difference between the two groups(P > 0.05).In this study, the tumor cells form spindle cell type in 123 cases, 13 cases of epithelioid type, other pleomorphic cell morphology in 49 cases. Endoscopic group: 72 cases with CD117 positive expression, the positive rate was 90%, 56 cases were CD34 positive, the positive rate was 70%, 29 cases were SMA positive, the positive rate was 36.3%, 18 cases were S-100 positive, the positive rate was 22.5%; the laparotomy group: 97 cases of CD117 positive expression, the positive rate was 92.4%, 76 cases were CD34 positive, the positive rate was 72.4%, 36 cases were SMA positive, the positive rate was 34.3%, 16 cases were S-100 positive, the positive rate was 17.1%; there was no significant difference between the two groups(P > 0.05).5. Endoscopic treatment: group of 80 cases, the average operation time was 156.5±54.2 min(range: 59 ~ 235 min); 105 cases in the laparotomy group, the average operation time was 136.9±58.4(range: 59 ~ 254 min), no statistical difference between the two groups(P > 0.05). Endoscopic group anal exhaust time shorter than the laparotomy group(endoscopic group: 1.4±0.8 days, laparotomy group: 4.8±2.1 days). Postoperative hospitalization time is shorter than the laparotomy group Endoscopy Group(endoscopic group: 5.6±2.3 days, laparotomy group: 10.7±3.5 days), there was significant difference between two groups(P < 0.05); no significant difference between the endoscopic treatment group and laparotomy operation group the postoperative complications(P > 0.05). The hospitalization expenses in endoscopic group 29583.4±7358.2, 32785.2±17680.5 yuan open group, no significant difference between two groups(P > 0.05).Conclusion:1. The clinical features and serology GIST lack of specificity.2. Endoscopic ultrasonography and imaging examination are the main methods of GIST, but the diagnosis still needs to be confirmed and immunohistochemistry.3. The treatment of GIST is safe, feasible and effective, and is short in hospital, and is expected to become one of the first choice of surgery, and the bigger GIST should choose open operation.
|
PDF Full Text Request