胃肠间质瘤围手术期死亡8例分析  

Analysis of perioperative deaths in 8 patients with gastrointestinal stromal tumors

作　　者：毛淦 吕剑波 陈志亮 田红坤 万雅琪 蒋祈 曾祥宇[1] 张鹏[1] 陶凯雄[1] MAO Gan;LYUJ Jian-bo;CHEN Zhi-liang(Department of Gastrointestinal Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院胃肠外科,湖北武汉430022

出　　处：《中国实用外科杂志》2024年第8期932-936,共5页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金项目(No.81702386,No.82072736);湖北省自然科学基金面上项目(No.2021CFB566);白求恩·胃肠间质瘤精准治疗专项研究基金项目(No.WCJZL202107)。

摘　　要：目的分析胃肠间质瘤(GIST)病人围手术期死亡病例临床病理学资料,为临床诊治提供参考。方法回顾性分析2019年1月至2023年6月华中科技大学同济医学院附属协和医院胃肠外科行手术治疗且出现围手术期死亡的8例GIST病人的临床病理学资料。结果8例病人中,3例初次手术病人及4例复发转移病人接受靶向药物治疗,1例病人因急腹症未行靶向治疗。7例接受靶向药物治疗病人中,6例达到靶向治疗最大效应后行手术治疗,1例因疾病进展行手术治疗。中位手术时间为240(160~435)min;中位出血量为450(50~4500)mL。4例术后复发病人中,1例于术后28 d因肺癌术后并发症(急性呼吸窘迫综合征)死亡;1例术后出现失血性休克,行二次手术探查发现左侧膈肌创面渗血,于术后1 d因腹腔出血死亡;1例术后出现感染性休克,二次手术取止血垫后感染症状未缓解,于术后15 d因感染性休克死亡;1例术后感染新型冠状病毒肺炎,出现低氧血症及呼吸窘迫,对症治疗后于术后8 d死亡。3例初次手术病人中,1例术后13 d突发呕血,行输血、急诊内镜止血治疗无效后死亡;1例术后7 d出现腹腔出血,行数字减影血管造影肝总动脉栓塞后成功止血,转入重症监护室后出现弥散性血管内凝血,于术后8 d死亡;1例因术中失血过多,行药物止血、输血等治疗无效,于术后2 d死亡。1例术中瘤内坏死感染灶入血导致脓毒血症及感染性休克,给予抗感染、抗休克等治疗无效,于术后1 d死亡。结论对于行术前靶向治疗、复发转移多线靶向治疗并伴高手术风险行外科手术的GIST病人,临床医师术前应积极开展多学科讨论,严格把控手术适应证,充分停用靶向药物,纠正不良反应、改善术前状况,术中精细操作减少创面出血及肿瘤破裂风险,并加强术后管理,有望降低GIST病人围手术期死亡风险。Objective The clinicopathological data of perioperative death cases of patients with gastrointestinal stromal tumors(GIST)were analyzed to provide a reference for clinical diagnosis and treatment.Methods The clinicopathological data of 8 GIST patients who died during the perioperative period after surgery in the Department of Gastrointestinal Surgery of Union Hospital,Tongji Medical College,Huazhong University of Science and Technology were retrospectively analyzed.Results Among the 8 patients,3 patients were treated preoperatively and 4 patients with recurrence and metastasis received targeted drug therapy.One patient did not receive targeted therapy due to an acute abdomen.Among the 7 patients with targeted therapy,6 patients underwent surgery after reaching the maximum effect of targeted therapy,and 1 patient underwent surgical treatment due to disease progression.The median operation time was 240(160~435)min;the median bleeding volume was 450(50~4500)mL.Among the 4 patients with postoperative recurrence,1 patient died 28 days after surgery due to postoperative complications of lung cancer(acute respiratory distress syndrome);one patient suffered hemorrhagic shock after surgery,and bleeding was found to ooze from the wound surface of the left diaphragm during the second surgical exploration and died 1 day after the operation due to intra-abdominal hemorrhage;one patient developed septic shock after the operation,and the infection symptoms were not relieved after removing the compression pad during the second operation,and the patient died due to septic shock 15 days after the operation;one patient was infected with new coronavirus pneumonia after surgery,developed hypoxemia and respiratory distress,and died 8 days after surgery after symptomatic treatment.Among the 3 patients who received preoperative treatment,1 patient suddenly vomited blood 13 days after surgery and died due to the ineffective treatment of blood transfusion and emergency endoscopic hemostasis;one patient developed abdominal bleeding 7 days

关 键 词：胃肠间质瘤 围手术期 死亡 靶向治疗 

分 类 号：R6[医药卫生—外科学]