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The first part of the endoscopic treatment of upper gastrointestinal submucosal tumor evaluation background: constantly updated with the endoscopic equipment, the development of the endoscopic techniques, endoscopy and endoscopic therapy has become the clinicians to diagnose disease, the treatment of patients an important means. Conventional endoscopy found inflammation, ulcers, tumors and other lesions with the histological examination of biopsy to determine the nature of the lesion. Submucosal tumor is frequently found lesions gastroscopy, the performance of To uplift the lesions, the smooth surface of the mucous membrane, the top may have ulcers, see the bridge around the mucosal folds. Extraluminal organs by ultrasound endoscopy to get rid of oppression, such as aortic pressure trace, liver and spleen pressure trace pancreas cyst pressure trace, gallbladder pressure trace, the difference between submucosal lesions as cysts, varicose veins, the nature of the submucosal tumor can make a preliminary determination as lipoma, leiomyoma or stromal tumors. At present, the commonly used endoscopic submucosal tumor mainly three: endoscopic ligation Endoscopic submucosal dissection (endoscopic submucosal dissection, ESD) and endoscopic submucosal resection (endoscopic mucosal resection, EMR ). The three methods have their pros and cons. Objective: To compare endoscopic ligation ESD treatment of submucosal tumor efficacy and security. Methods: Retrospective line of ordinary endoscopy or endoscopic ultrasonography Zhongshan Hospital, Fudan University, January 2006 to January 2009 found that upper gastrointestinal submucosal tumor, and patients receiving endoscopic ligation or ESD treatment to lesions disappear or lesions shrink more than 50% is defined as the treatment is effective, compare the treatment efficiency and safety. Results: A total of 332 patients in this group research standards, including 178 cases of female, male 154 cases. Ligation group of 146 patients lost to 27 cases, residual lesions> 50% of the nine cases, an effective rate of 75.3%. The ESD group removing lost to the 36 cases, are effective treatment, the effective rate of 80.2%. Differences in follow-up results of the statistical analysis, visible ligation group residual disease was significantly more than the ESD group. The average operation time of the two treatment methods, ligation of 10.3 ± 6.7min, the ESD to 37.9 ± 27.6min longer visible ESD operation, are also more prone to complications. Ligation group, only one case of perforation in the United ESD treatment process, the ESD group, 14 cases complicated by perforation, perforation rate of 7.7% (14/182), two cases of bleeding accounted for 1.1% (2/182). The study analyzed the complications perforation related factors, found submucosal tumor involving the mucosa of depth and treatment selection and perforation. Conclusions: ESD treatment the lesions clear than ligation thoroughly, but the incidence of complications was significantly higher than ligation. Prognostic factors evaluation of the background of the second part of the stomach stromal tumors: gastrointestinal submucosal tumor of stromal tumors (the gastrointestinal stromal tumorsGIST), special pathological and immunohistochemical features such tumors. In recent years, about the treatment of GIST Guide updated faster. For a larger stromal tumors, the guidelines recommend radical surgery for a smaller stromal tumors, however, choose the follow-up, surgical resection or endoscopic therapy is still controversial. Objective: To investigate the factors affecting the prognosis of gastric stromal tumors, to provide a reference to the choice of treatment. Methods: Retrospective January 2006 to January 2009, Zhongshan Hospital, Fudan ESD treatment of upper gastrointestinal submucosal tumor line pathological diagnosis of gastric stromal tumor patients and from January 2003 to January 2009, surgical postoperative pathological diagnosis of stromal tumors in the stomach. Explore the factors affecting the prognosis of gastric stromal tumors. Results: The average tumor size of patients with endoscopic therapy group for 1.4 ± 0.7 cm, the surgical group of patients the average size of 7.6 ± 5.5cm; endoscopic group of patients before treatment underwent ultrasound endoscopy, the tumor is basically limited to the muscularis mucosa or inherent myometrium, not exploration and lymph node invasion, the part of the patient in the surgical group of patients in the preoperative examination, imaging studies have prompted the surrounding organs or distant metastasis. Follow-up after treatment, the survival rate, half of the patients of the surgical group of patients tumor recurrence or metastasis 14.97. 3 months, 6 months, 1 year, 1.5 years, the 2-year recurrence rate was 4.4%, 7.0%, 6.7%, 4.5%, 3.1%. Endoscopic treatment group patients were followed up, showed no tumor recurrence and metastasis. Surgical group of patients with pathological results are shown tumor cell division like <5/50 the HPF those 24 cases ,5-10/50 HPF in 29 cases,> 10/50 the HPF those 37 cases. Borderline low grade accounted for 32.2% (29/90) to - severe malignant accounted for 67.8% (61/90); tumor cell division in the endoscopic treatment group patients like were <5/50 the HPF for low malignant or borderline tumors. Logistic regression analysis, the degree of malignancy of the ELISA results stromal tumor CD117-positive stromal tumors in - the risk of severe malignant 3.60, 95% confidence interval (1.07,12.17), CD117 positive for an independent risk factor for the degree of malignancy of stromal tumors. Conclusions: Endoscopic treatment group of patients relapse rate is lower than the surgical group, the impact may GIST prognosis and tumor size, tumor cell division like its microplate CD117, CD34, desmin, S-100 related CD117-positive may be inter- an independent risk factor for the degree of malignancy of stromal tumors.
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