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目的探讨超声评估小肠间质瘤恶性风险的价值。方法回顾性分析经手术病理和免疫组化证实的55例小肠间质瘤患者的声像图表现,依据胃肠道间质瘤(gastrointestinal stromal tumor,GIST)病理危险度分级将其分为低危组、中危组、高危组;声像图分析包括肿瘤的大小、形态、边界、内部回声,并对各组的上述征象进行方差分析或Fisher精确检验。结果 55例小肠间质瘤中,低危组患者有8例,中危组患者有3例,高危组患者有44例。病灶最大径为3.5~28.0 cm;低危组病灶平均大小为4.3 cm,中危组为7.2 cm,高危组为11.2 cm。与低危组患者中出现回声不均、分叶、囊变的比例(25.0%、37.5%、25.0%)相比,中危组和高危组的比例高,分别为100.0%、100.0%、66.7%和88.6%、86.4%、81.8%;肿瘤大小、回声均质性、分叶、囊变在不同组间的差异有显著的统计学意义(均P<0.05)。不同危险度分组中,肿瘤内有气体回声的比例在中危组(1/3,33.3%)和高危组(8/44,18.2%)中均高于低危组(0/8,0);血流丰富的比例在高危组(17/44,38.6%)中的比例高于低危组(0/8,0)和中危组(1/8,12.5%),但无统计学意义(P>0.05)。结论超声对评估小肠间质瘤恶性风险有一定价值。
Objective To investigate the value of ultrasonography in evaluating the malignant risk of small intestinal stromal tumors. Methods We retrospectively analyzed the echocardiographic findings of 55 patients with small intestinal stromal tumor confirmed by surgery and pathology and immunohistochemistry. According to the pathological grade of gastrointestinal stromal tumor (GIST), they were classified as low risk Group, medium-risk group and high-risk group. The sonographic analysis included the size, shape, boundary and internal echo of the tumor, and ANOVA or Fisher’s exact test of the above signs in each group. Results Of the 55 cases of small intestinal stromal tumors, 8 were in the low risk group, 3 were in the intermediate risk group, and 44 were in the high risk group. The maximum diameter of the lesions was 3.5-28.0 cm. The average size of the lesions in the low-risk group was 4.3 cm, that in the intermediate-risk group was 7.2 cm, and that in the high-risk group was 11.2 cm. Compared with the low-risk group of patients with echogenic, lobulated, cystic changes (25.0%, 37.5%, 25.0%), the proportion of high-risk group and high-risk group were 100.0%, 100.0%, 66.7 %, 88.6%, 86.4%, 81.8% respectively. There were significant differences in tumor size, echo homogeneity, lobulation and cystic change among different groups (all P <0.05). In different risk groups, the proportion of gas echoes in tumors was higher in the moderate-risk group (1 / 3,33.3%) and in the high-risk group (8 / 44,18.2%) than in the low risk group (0 / 8,0) ; The proportion of blood-rich in high-risk group (17 / 44,38.6%) was higher than that in low-risk group (0 / 8,0) and intermediate risk group (1/8, 12.5%), but no statistical significance (P> 0.05). Conclusion Ultrasound has some value in assessing the malignant risk of small intestinal stromal tumors.