上消化道SMT病理类型及超声内镜下特征研究-现代医学

上消化道SMT病理类型及超声内镜下特征研究

单位：宿迁市第一人民医院消化内科, 江苏宿迁 223800

分类号：R445.1

出版年·卷·期（页码）：2020·39·第八期（978-983）

摘要：

目的：探讨上消化道黏膜下肿瘤（submucosal tumor，SMT）病理类型及超声内镜下特征。方法：回顾性分析我院2016年6月至2019年12月收治消化道SMT患者共285例临床资料，分析一般资料、病变部位、病理类型、起源部位及超声内镜下特征。结果：①食管SMT患者124例次中，病变位于食管上段共35例次，占总数28.23%；食管中段共42例次，占总数33.87%；食管下段共47例次，占总数37.90%；均以平滑肌瘤最为常见。②胃SMT患者149例次中，贲门部14例次，占总数9.39%，以平滑肌瘤和间质瘤最为常见；胃底部51例次，占总数34.23%，以间质瘤和平滑肌瘤最为常见；胃体上部例45次，占总数30.20%，以平滑肌瘤和间质瘤最为常见；胃体中部7例次，占总数4.70%，以间质瘤和平滑肌瘤最为常见；胃体下部5例次，占总数3.36%，以平滑肌瘤和异位胰腺最为常见；胃角1例次，占总数0.67%；胃窦部26例次，占总数17.45%，以异位胰腺和间质瘤最为常见。③十二指肠SMT共12例次，其中十二指肠球部10例次，占总数83.33%，以囊肿最为常见；十二指肠降部2例次，占总数16.67%，以脂肪瘤最为常见。④食管SMT超声内镜类型诊断和术后病理诊断总符合率为92.74%（115/124），其中平滑肌瘤诊断总符合率为98.06％（101/103），囊肿诊断总符合率为为72.73%（8/11）。⑤胃SMT超声内镜类型诊断和术后病理诊断总符合率为93.29%（139/149）；其中间质瘤和平滑肌瘤诊断总符合率为100.00%（115/115）；异位胰腺诊断总符合率为86.67%（13/15）。⑥十二指肠超声内镜类型诊断和术后病理诊断总符合率为58.33%（7/12）；其中囊肿诊断总符合率66.67%（4/6），脂肪瘤诊断总符合率75.00%（3/4）。⑦食管和胃SMT超声内镜类型诊断和术后病理诊断总符合率均显著高于十二指肠（P<0.05）。结论：食管和贲门部SMT多属于平滑肌瘤，胃底和胃体SMT则以平滑肌瘤和间质瘤居多，胃窦和十二指肠SMT主要病理类型则为异位胰腺、囊肿及脂肪瘤；同时不同部位不同类型SMT均有特殊超声内镜下特征。

Objective: To investigate the pathological types and endoscopic features of SMT in upper gastrointestinal tract.Methods: Clinical data of 285 patients with SMT in upper gastrointestinal tract were retrospectively chosen in the period from June 2016 to December 2019. The general data, pathological location, pathological type, origin and endoscopic features were analyzed.Results: ① In total of 124 cases for esophageal SMT, 35 were located in the upper esophagus, accounting for 28.23%; 42 in the middle esophagus, accounting for 33.87%; 47 in the lower esophagus, accounting for 37.90%; leiomyoma was the most common. ② In total of 149 cases for gastric SMT, 14 cases were in the cardia, accounting for 9.39%, leiomyoma and stromal tumor were the most common; 51 cases were in the bottom of the stomach, accounting for 34.23%, stromal tumor and leiomyoma were the most common; 45 cases were in the upper part of the stomach, accounting for 30.20%, leiomyoma and stromal tumor were the most common; 7 cases were in the middle of the stomach, accounting for 4.70%, stromal tumor and leiomyoma were the most common. There were 5 cases in the lower part of the stomach, accounting for 3.36% of the total, with leiomyoma and ectopic pancreas the most common; 1 cases in the angle of the stomach, accounting for 0.67% of the total; 26 cases in the antrum, accounting for 17.45%, with ectopic pancreas and stromal tumor the most common. ③ In total of 12 cases for duodenal SMT, 10 cases were in the duodenal bulb, accounting for 83.33%, cyst were the most common; 2 cases were in the duodenal descending part, accounting for 16.67%, lipoma were the most common. ④ The total coincidence rate of endoscopic type diagnosis and postoperative pathological diagnosis of esophageal SMT was 92.74% (115/124), including leiomyoma for 98.06% (101/103) and cyst for 72.73% (8/11). ⑤ The total coincidence rate of endoscopic type diagnosis and postoperative pathological diagnosis of gastric SMT was 93.29% (139/149), including stromal tumor and leiomyoma for 100.00% (115/115) and ectopic pancreas for 86.67% (13/15). ⑥ The total coincidence rate of endoscopic type diagnosis and postoperative pathological diagnosis of duodenum SMT was 58.33% (7/12), including cyst for 66.67% (4/6) and lipoma for 75.00% (3/4). ⑦ The total coincidence rate of endoscopic and postoperative pathological diagnosis of esophageal and gastric SMT were significantly higher than duodenum(P<0.05). Conclusion: Most of SMT in esophagus and cardia belong to leiomyoma, most of SMT in fundus and body of stomach are leiomyoma and stromal tumor, and the main pathological types of SMT in antrum and duodenum are heterotopic pancreas, cyst and lipoma. Then different types of SMT in different parts have special endoscopic characteristics.

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