探讨超声内镜对胃固有肌层间质瘤的诊断价值及黏膜下挖除术临床应用的疗效及安全性。

30例经超声内镜初步诊断为来源于胃固有肌层的间质瘤患者，经超声内镜明确病变来源、回声、大小、血供等情况后行黏膜下挖除治疗，观察其疗效及并发症。对超声诊断结果与病理结果进行比较。参照病理侵袭危险性分级结果，计算超声内镜侵袭危险性分级的准确性。运用SPSS 11.0软件系统进行统计，采用Kappa评价标准进行一致性分析，Kappa值判断标准：Kappa≥0.75两者一致性较好；0.75>Kappa≥0.4两者一致性一般；Kappa<0.4两者一致性较差。

超声内镜显示，病变位于胃底16例(其中近贲门处8例)，胃体8例，胃窦4例，胃体胃底交界处1例，胃体胃窦交界处1例。内镜下间质瘤直径为0.4～5.5cm。22例直径小于3cm病变内镜下呈球形或半球形隆起，超声内镜显示均表现为均匀偏低-低回声团块，边缘光滑。8例病变直径长于3cm，4例表现为半球形隆起，3例呈不规则隆起。超声内镜对胃间质瘤侵袭危险性分级与病理分级判断结果相符27例；29例病变均完整挖除，1例部分挖除；术中穿孔3例，钛夹封闭创面后内科治愈。术中均有少量出血，行热活检钳钳夹或氩气凝固等止血后出血停止，未发生迟发性出血。

超声内镜下胃间质瘤侵袭危险性分级与病理分级具有良好的一致性；黏膜下挖除术治疗胃固有肌层间质瘤安全有效，术前行超声内镜进行严格评估具有重要辅助价值。

To evaluate the efficacy of endoscopic ultrasonography in diagnosis of gastric stromal tumor and the efficacy and safety of the application of endoscopic submucosal excavation in the treatment of gastric stromal tumor.

Thirty patients with gastric stromal tumor was diagnosed by endoscopic ultrasonography which confirmed origin, size, location, blood supply of the lesions, then treated by endoscopic submucosal excavation, evaluating the efficacy and safety.The results were compared with the postoperative findings.The Kappa evaluation criterion was used to analyze the consistency.

Endoscopic ultrasonography showed gastric stromal tumors were predominantly located in the bottom and body of stomach.The diameters were between 0.4 and 5.5centimeters.Twenty-two lesions whose diameter less than 3cm appeared spherical or hemispherical uplift, showing homogeneous hypoechoic or intermediate internal echo under endoscopic ultrasonography.The diameters of eight lesions were more than 3cm longer.Twenty-nine tumors were completely removed by endoscopic submucosal excavation and one tumor was partly removed.Three patients were perforated during the operation, then cured by conservative therapy.Mild bleeding occurred in all cases, then managed by argon plasma coagulation or hot biopsy.Twenty-seven cases were consistent in the invasion risk classificational of gastric stromal tumor under endoscopic ultrasonography and pathologic classification.The Kappa evaluation criterion was used to analyze the consistency.

The invasion risk classification of gastric stromal tumor under endoscopic ultrasonography has good consistency with pathologic classification.Endoscopic submucosal excavation is safe and effective, and the use of endoscopic ultrasonography for evaluating lesions before treatment is very important.