本文選題：上消化道黏膜下病變 + 超聲內鏡　； 參考：《蚌埠醫(yī)學院》2017年碩士論文

【摘要】：目的:隨著常規(guī)胃鏡的普及及超聲內鏡技術的發(fā)展,上消化道黏膜下病變(Upper gastrointestinal submucosal lesions,SML)的檢出率不斷提高,不同病理類型的SML的治療原則及預后不盡相同。本文主要通過研究不同部位SML的好發(fā)年齡、病變來源層次、常見病理類型的差異,以提高臨床的SML的診斷水平。方法:回顧性分析我院2015年1月至2016年12月經(jīng)超聲內鏡及術后病理確診為SML的295例患者的臨床資料,觀察SML常規(guī)胃鏡下表現(xiàn),收集超聲胃鏡下不同部位SML的大小、回聲特點、來源層次等特征,及術后病理結果。分析不同部位的性別構成比、年齡構成比、來源層次構成比、病理類型構成之間的統(tǒng)計學差異,及間質瘤與平滑肌瘤的免疫組化結果的差異。結果:295例患者中位于食管者139例、賁門17例、胃底34例、胃體32例、胃竇59例、十二指腸14例,男女比例為1:1.35,平均年齡51.3±10.9歲,病變平均直徑為9.36±4.47mm,SML好發(fā)于食管(47.1%)及胃部(48.1%),胃部以胃竇部(20%)常見,不同部位SML的年齡構成比、起源層次構成比、病理類型構成比不同,差異均有統(tǒng)計學意義(P0.05);不同部位SML腫物大小不同,差異有統(tǒng)計學意義(P0.05),食管及十二指腸病變相對于其他部位偏小。不同部位SML患者性別構成比,差異無統(tǒng)計學意義(P0.05)。平滑肌瘤、異位胰腺、間質瘤、脂肪瘤超聲內鏡下表現(xiàn)不同。平滑肌瘤中SMA陽性率為98.5%,間質瘤中CD117陽性率為85.7%,CD34為78.5%、DOG-1為78.5%。結論:不同部位SML的好發(fā)年齡、常見表現(xiàn)、病變起源層次、病理類型不盡相同,超聲內鏡是診斷上消化道SML的有效方法,異位胰腺及脂肪瘤好發(fā)于黏膜下層,平滑肌瘤好發(fā)于黏膜肌層,間質瘤好發(fā)于固有肌層。CD117、CD34、DOG-1、SMA是平滑肌瘤與間質瘤鑒別的重要免疫標記物。
[Abstract]:Objective: with the popularization of conventional gastroscopy and the development of endoscopic ultrasonography, the detection rate of upper gastrointestinal submucosal lesions in upper gastrointestinal tract submucosal lesions is increasing, and the treatment principles and prognosis of different pathological types of SML are different. In order to improve the diagnostic level of SML, the authors studied the differences of the predilection age, pathological origin and common pathological types of SML in different sites. Methods: the clinical data of 295 patients with SML diagnosed by endoscopic ultrasonography and postoperative pathology from January 2015 to December 2016 in our hospital were analyzed retrospectively. The features of SML in different parts of SML were collected. Source level and other features, and postoperative pathological results. The differences of sex ratio, age ratio, origin level ratio, pathological type composition and immunohistochemical results between stromal tumors and leiomyomas were analyzed. Results among the 295 patients, 139 were located in esophagus, 17 in cardia, 34 in fundus, 32 in body, 59 in antrum and 14 in duodenum. The ratio of male to female was 1: 1.35 with an average age of 51.3 鹵10.9 years. The mean diameter of the lesion was 9.36 鹵4.47mmSML, which occurred in the esophagus (47.1) and the stomach (48.1g). The gastric antrum was 20%). The age composition ratio, the origin level ratio and the pathological type ratio of SML in different parts were different. The difference was statistically significant (P 0.05), the size of SML tumor was different in different parts, the difference was statistically significant (P 0.05), and the esophageal and duodenal lesions were smaller than those in other parts. There was no significant difference in sex composition ratio of SML patients in different sites (P 0.05). Leiomyoma, ectopic pancreas, stromal tumor and lipoma show different endoscopic findings. The positive rate of SMA in leiomyoma was 98.5 and the positive rate of CD117 in stromal tumor was 85.7and CD34 was 78.5 and DOG-1 was 78.5. Conclusion: the predilection age, common manifestation, origin and pathological type of SML in different sites are different. EUS is an effective method for the diagnosis of SML in upper digestive tract. Ectopic pancreas and lipoma usually occur in submucosa. Leiomyoma usually occurs in the myometrium of mucous membrane and stromal tumors in the myometrium propria. CD117 and CD34-DOG-1 SMA are important immunomarkers for differentiating leiomyoma from stromal tumor.
【學位授予單位】：蚌埠醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R57

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