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中华胃肠内镜电子杂志

中华胃肠内镜电子杂志 ›› 2025, Vol. 12 ›› Issue (02) : 96 -102. doi: 10.3877/cma.j.issn.2095-7157.2025.02.006

论著

基于胃部黏膜下肿瘤的生长方式探讨内镜下治疗策略和疗效分析
陆友祝1, 丁永刚1, 范钦梅1, 李方圆1, 吴大鹏1, 王磊1, 周玉宏1, 张其德1,†()   
  1. 1. 210029 南京,南京中医药大学附属医院(江苏省中医院),消化内镜中心
  • 收稿日期:2025-02-03 出版日期:2025-05-15
  • 通信作者: 张其德
  • 基金资助:
    江苏省卫生健康委老年健康项目(LKM2022003)江苏省中医院重点病种创建项目(YZJ2407)

Exploring endoscopic treatment strategies and efficacy analysis based on the growth pattern of gastric submucosal tumors

Youzhu Lu1, Yonggang Ding1, Qinmei Fan1, Fangyuan Li1, Dapeng Wu1, Lei Wang1, Yuhong Zhou1, Qide Zhang1,†()   

  1. 1. Digestive Endoscopic Center, Jiangsu Province Hospital of Chinese Medicine,Nanjing 210029, China
  • Received:2025-02-03 Published:2025-05-15
  • Corresponding author: Qide Zhang
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陆友祝, 丁永刚, 范钦梅, 李方圆, 吴大鹏, 王磊, 周玉宏, 张其德. 基于胃部黏膜下肿瘤的生长方式探讨内镜下治疗策略和疗效分析[J/OL]. 中华胃肠内镜电子杂志, 2025, 12(02): 96-102.

Youzhu Lu, Yonggang Ding, Qinmei Fan, Fangyuan Li, Dapeng Wu, Lei Wang, Yuhong Zhou, Qide Zhang. Exploring endoscopic treatment strategies and efficacy analysis based on the growth pattern of gastric submucosal tumors[J/OL]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2025, 12(02): 96-102.

目的

本文拟探讨基于胃SMT 生长方式对内镜下治疗策略的选择和疗效分析。

方法

回顾性收集2014 年1 月至2024 年8 月经江苏省中医院消化内镜中心住院治疗的143 例胃SMT 患者,根据超声内镜(EUS)及CT 检查判断其生长方式,分析其内镜下治疗策略选择、治疗效果、并发症等。

结果

143 例患者,腔内组63 例、壁内组50 例及腔外组30 例;男58 例、女85 例,平均年龄为(57.84 ±11.99)岁。 三组患者的年龄、性别、生长部位、瘤体直径、手术时间、内镜完整切除率及病理类型等资料比较无显著差异(P>0.05)。 腔外组及壁内组的EFR 比率、荷包缝合率及胃管留置率均显著高于腔内组(P <0.001,0.002,<0.001),进一步进行多因素回归分析结果显示仅各组间手术方式仍存在统计学差异(P =0. 011),创面缝合方式及胃管留置率差异无统计学意义(P =0. 159,0.131)。 腔内组及壁内组根据SMT 生长部位的亚组分析显示:位于胃底部位的病灶EFR 比率显著高于非胃底部位(P=0.049,0.021),进一步进行多因素分析结果显示仅壁内组中胃底部位的EFR 比率显著高于非胃底部位(P=0.003)。

结论

胃SMT 内镜下治疗安全有效,腔内型及非胃底部位的壁内型SMT 以ESE 治疗为主,胃底部位的壁内型及所有腔外型SMT 需行EFR。 基于胃SMT 生长方式对内镜治疗策略选择有指导意义,有助于术前准备及围手术期管理。

关键词: 黏膜下肿瘤, 生长方式, 内镜黏膜下挖除术, 内镜下全层切除术

Objective

This article aims to explore the selection and efficacy of endoscopic treatment strategies based on gastric SMT growth pattern.

Methods

A retrospective collection was conducted on 143 patients with gastric SMT who were hospitalized at the Digestive Endoscopy Center of Jiangsu Provincial Hospital of Chinese Medicine from January 2014 to August 2024. Their growth patterns were determined based on endoscopic ultrasound (EUS) or CT scans,and the selection of endoscopic treatment strategies,effects,and complications were analyzed.

Results

Among 143 patients, 63 were in the endoluminal group,50 in the intramural group and 30 in the extraluminal group; There were 58 males and 85 females with an average age of (57.84 ±11.99) years. There was no significant difference in age, sex, growth site, tumor diameter, operation time, endoscopic complete resection rate and pathological type among the three groups(P>0.05). The EFR rate, purse string suture rate and gastric tube indwelling rate in the extraluminal group and intramural group were significantly higher than those in the luminal group (P< 0.001,0.002, <0.001). Further multivariate regression analysis showed that only the surgical methods between these groups were still statistically different (P=0.011), but the wound suture method and gastric tube indwelling rate were not statistically significant (P=0.159,0.131). Subgroup analysis showed that the EFR rate of lesions located in the fundus of stomach was significantly higher than that of non-fundus of stomach (P =0.049,0.021). Further multivariate analysis showed that the EFR rate of lesions located in the fundus of stomach was significantly higher than that of non-fundus of stomach in the intramural group only (P =0. 003).

Conclusion

Endoscopic treatment of gastric SMT is safe and effective. ESE treatment is mainly used for intracavitary and intramural SMT in non gastric fundus areas, while EFR treatment is required for intramural SMT in gastric fundus areas and all extraluminal SMT. The growth pattern of gastric SMT has guiding significance for the selection of endoscopic treatment strategies, which is helpful for preoperative preparation and perioperative management.

Key words: Submucosal tumors, Endoscopic submucosal excavation, Endoscopic full-thickness resection, Growth pattern
表1 入组患者临床基本资料[例,()]
项目 患者总数（n = 143）
年龄[岁,（x̄ ± s）] 57.84 ± 11.99
性别
男 58
女 85
生长方式
腔内型 50
壁内型 63
腔外型 30
部位
胃底 75
胃体 60
胃角 3
胃窦 5
瘤体直径[cm,（x̄ ± s）] 2.47 ± 1.01
手术方式
ESE 56
EFR 87
手术时间[min,（x̄ ± s）] 34.37 ± 18.21
创面闭合方式
钛夹夹闭 98
荷包缝合 45
留置胃管
是 85
否 58
内镜完整切除
是 138
否 5
病理类型
间质瘤 98
平滑肌瘤 37
神经鞘瘤 4
钙化性纤维瘤 4
表2 腔内型、壁内型及腔外型胃SMT 患者资料比较(例)
项目 腔内型（n = 63） 壁内型（n = 50） 腔外型（n = 30） P 值 P' 值
年龄（岁） 57.83 56.92 59.4 0.65
性别 0.66
男 27 21 10
女 36 29 20
部位 0.25
胃底 36 25 13
胃体 26 22 13
胃角 0 2 1
胃窦 1 1 3
瘤体直径[cm,（x̄ ± s）] 2.53 ± 0.92 2.43 ± 1.10 2.40 ± 1.05 0.30
手术方式 <0.001 0.011
ESE 38 17 0
EFR 25 33 30
手术时间[min,（x̄ ± s）] 31.29 ± 15.16 33.24 ± 16.45 42.73 ± 24.09 0.15
创面闭合方式 0.002 0.159
钛夹夹闭 52 31 15
荷包缝合 11 19 15
留置胃管 <0.001 0.131
是 28 31 26
否 35 19 4
内镜完整切除 0.971
是 61 48 29
否 2 2 1
病理类型 0.079
间质瘤 42 29 26
平滑肌瘤 20 16 1
神经鞘瘤 1 2 1
钙化性纤维瘤 0 3 2
表3 腔内型及壁内型胃SMT 亚组分析(例)
项目 腔内型 P 值 P' 值 壁内型 P 值 P' 值
ESE EFR ESE EFR
年龄[岁,（x̄ ± s）] 56.92 ± 14.02 59.2 ± 10.12 0.48 54.65 ± 14.62 58.09 ± 11.51 0.36
性别 0.026 0.048 0.2
男 12 15 5 16
女 26 10 12 17
部位 0.049 0.062 0.021 0.003
胃底 18 18 4 21
胃体 19 7 11 11
胃角 0 0 2 0
胃窦 1 0 0 1
瘤体直径[cm,（x̄ ± s）] 2.5 ± 0.98 2.58 ± 0.85 0.75 2.42 ± 0.93 2.43 ± 1.19 0.83
手术时间[min,（x̄ ± s）] 27.66 ± 12.91 36.8 ± 16.86 0.08 28.88 ± 14.45 35.48 ± 17.17 0.18
创面闭合方式 <0.001 0.067 <0.001 0.008
钛夹夹闭 37 15 16 15
荷包缝合 1 10 1 18
留置胃管 0.011 0.011 0.005 <0.001
是 12 16 6 25
否 26 9 11 8
内镜完整切除 0.77 0.63
是 37 24 16 32
否 1 1 1 1
病理类型 <0.001 0.001 0.042 0.036
间质瘤 19 23 5 25
平滑肌瘤 18 2 11 5
神经鞘瘤 1 0 0 2
钙化性纤维瘤 0 0 1 1
图1 腔内型胃SMT 注:A:SMT 白光内镜下表现;B:CT 平扫;C:EUS 图像;D:切除瘤体体外测量
图2 壁内型胃SMT 注:A:SMT 白光内镜下表现;B:CT 平扫图像;C:EUS 图像;D:切除瘤体体外测量
图3 腔外型胃SMT 注:A:SMT 白光内镜下表现;B:CT 增强图像;C:EUS 图像;D:切除瘤体体外测量
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