胃间质瘤临床诊治和预后分析:附35例报告  

Clinical experiences of gastric gastrointestinal stromal tumors: 35 cases report

作　　者：王昕海[1] 吴双杰[1] 李孟军[1] 辛国明[1] 唐一帆[1] 

机构地区：[1]复旦大学附属华山医院普外科,上海200040

出　　处：《外科理论与实践》2012年第2期139-142,共4页Journal of Surgery Concepts & Practice

摘　　要：目的:探讨胃间质瘤的临床特点,诊治经验和预后。方法:回顾性分析我院诊治的35例胃GIST病人的临床资料,并对临床特点、诊断、治疗以及预后进行报道,探讨该病复发转移的特点及影响预后的因素。结果:术前诊断正确率为68.6%肿瘤,中位直径7.0(1.5～14.0)cm。行胃楔形切除9例,胃部分切除23例,全胃切除3例;术后服用甲磺酸伊马替尼9例。CD117(+)100%,CD34(+)90.9%,Vim(+)79.3%,SMA(+)42.9%,S-100(+)26.9%。术后有6例出现复发转移,其中1例进行了再次手术。2例出现肝转移,3例后腹膜转移,1例腹腔广泛转移;2例死亡,4例带瘤生存。单因素分析发现,肿瘤直径≥5 cm、核分裂象≥5/50 HPF以及高危病人为胃GIST复发转移的预测因素。结论:胃GIST高危病人术后出现复发或转移的可能性大,即使出现复发、转移,也应积极再次手术,同时高危和复发转移者应配合甲磺酸伊马替尼辅助治疗。Objective To investigate the clinical characteristics,diagnosis,treatment and prognosis of gastric gastrointestinal stromal tumor（GIST）.Methods We retrospectively analyzed 35 cases of gastric GIST.The clinical characteristics,diagnosis,treatment and prognosis were compared.The predictive factors for postoperative recurrence and metastasis were analyzed.Results The correct rate of preoperative diagnosis was 68.6%.Tumor diameter ranges from 1.5 to 14.0 cm,with median diameter 7.0 cm.Nine cases received wedge gastrectomy,23 partial gastrectomy,and 3 total gastrectomy.Nine cases were subjected to imatinib mesylate therapy after surgery.The positive rate of CD117 was 100%,CD34 90.9%,Vim 79.3%,SMA 42.9%,and S-100 26.9%.Postoperative recurrence or metastasis occurred in 6 cases.One patient were re-operated.Two cases developed liver metastasis,3 retroperitoneal metastasis,and 1 extensive intra-peritoneal metastasis.Two patients died,and 4 survived with tumors.Univariate analysis showed that tumor diameter ≥ 5 cm,mitoses ≥ 5/50 HPF,and high-risk gastric GISTs were the factors associated with adverse outcome.Conclusions High risk gastric GISTs have higher possibilities of postoperative recurrence or metastasis.Even if the patients have recurrence or metastasis,re-operation is recommended.Patients with high-risk gastric GIST or recurrence developed should be treated with imatinibe mesylate.

关 键 词：胃间质瘤 诊断 治疗 预后 

分 类 号：R735.2[医药卫生—肿瘤]