胃肠道小间质瘤55例临床分析  

Clinical Analysis of 55 Patients with Small Intestinal Stromal Tumors

作　　者：尹光[1] 徐文通[1] 沈勇 刘利成[3] 菅锎宇 杨倚天[1] 

机构地区：[1]解放军总医院普通外科,北京100853 [2]武警河北总队医院军人病区,石家庄050081 [3]沧州市中心医院普通外科,河北沧州061001

出　　处：《解放军医药杂志》2014年第5期30-33,共4页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：全军"十二五"面上项目(CWS11J103)

摘　　要：目的：探讨胃肠道小间质瘤临床特点和诊治方法。方法回顾性分析解放军总医院2004年10月-2010年4月接受手术治疗的55例胃肠道小间质瘤患者的临床资料,同时进行随访分析。结果55例中有临床症状者占58.2%；胃部间质瘤占80.0%,其中胃上部间质瘤占52.7%。 Fletcher危险度分级极低和低度占92.7%,肿瘤直径≤1 cm危险度分级更低,Ki-67阳性与危险度分级无关。肿瘤切除采取微创手术者33例（微创手术组）,其中腹腔镜下切除17例,内镜下切除14例,双镜联合局部切除2例；采取传统开放手术者22例（开放手术组）,其中局部切除18例,近端胃切除3例,胰十二指肠切除1例。微创手术组较开放手术组术中出血量及术后开始进食时间差异均有统计学意义（P〈0.01,P〈0.05）。38例获得随访,随访时间26~104个月,中位时间41个月,仅1例胃体间质瘤内镜下切除术后22个月复发。结论胃肠道小间质瘤患者仅半数有临床症状,肿瘤多生长于胃上部,危险度分级及复发风险低,Ki-67不能作为判断胃肠道小间质瘤预后的指标。微创手术治疗安全、有效。Objective To investigate the clinical features, diagnosis and treatment methods of small gastrointes-tinal stromal tumors （ GISTs） . Methods Clinical data of 55 patients with small GISTs undergoing surgery during Octo-ber 2004 and April 2010 was retrospectively analyzed, and follow-up analysis was performed at the same time. Results Among the 55 small GISTs patients, the percentage of patients with clinical symptoms was 58. 2% and patients with gas-tric tumors were 80. 0% respectively including 52. 7% in upper stomach. The percentage of patients with very low and low grade of Flecture risk classification was 92. 7%, and risk classification of tumor diameter of no more than 1cm was lower, but positive Ki-67 had nothing to do with the risk classification. Minimally invasive tumor resection was performed in 33 cases （ minimally invasive group） including 17 cases of laparoscopic gastric partial resection, 14 cases of endoscop-ic submucosal dissection and 2 cases of laparoscopic combined with endoscopic surgery; open tumor resection was per-formed in 22 cases （ open tumor resection group） including 18 cases of gastric partial resection, 3 cases of proximal gas-trectomy and 1 case of pancreaticoduodenectomy. The differences in bleeding volum and postoperative dieting time be-tween the open surgery group and minimally invasive surgery group were statistically significant （P〈0. 01, P〈0. 05）. A total of 38 patients were followed up for 26-104 months, median time was 41 months, and only one patient had relapse 22 months after endoscopic submucosal dissection. Conclusion Only half of small GIST patients have clinical manifesta-tions, most of the tumors are located in the upper part of the stomach with low risk and recurrent risk, but Ki-67 can not be used as prognostic indicator of small GIST. Minimally invasive surgery is safe and effective.

关 键 词：胃肠道间质肿瘤 疾病特征 诊断 外科手术 随访研究 

分 类 号：R735.2[医药卫生—肿瘤] R735.3[医药卫生—临床医学]