胃间质瘤的外科治疗

Surgical Treatment of Gastric Stromal Tumor

目的分析胃的胃肠道间质瘤(gastrointestinal stromal tumor,GIST)外科治疗效果及其影响因素.方法总结我院1990年1月至2004年12月外科治疗的70例胃的GIST临床资料,对其病理切片(含免疫组织化学检查)重新复核并加以随访,分析手术切除的效果以及影响手术疗效的因素.结果行完全切除术63例,其中扩大切除术20例,肿瘤及所在器官切除24例,肿瘤局部切除19例;行不完全切除7例.全组中位生存时间为60.2月,术后1～、3～和5～年生存率分别为96.3%、72.1%和61.9%.完全切除术组患者生存率明显优于不完全切除术组(P＜0.05),后者无一例生存超过2年.完全切除术组中,肿瘤局部切除和肿瘤及所在器官切除患者生存率之间比较,差异无显著意义(P＞0.05),但二者分别与扩大切除术者比较,差异却有显著性意义(P＜0.05).完全切除术患者的生存率与其性别、肿瘤大小和性质、核分裂数及复发转移有关;但多因素的Cox回归分析显示,术后生存率仅与肿瘤大小、核分裂和复发转移相关(P＜0.05).结论胃的GIST仍以外科治疗为主,原则上施行肿瘤完全切除即可,广泛切除或扩大淋巴结清扫不能提高生存率.

Objective To investigate the outcome of surgical treatment for gastric gastrointestinal stromal tumor (GIST) and its correlating factors. Methods Seventy cases of GIST underwent surgical treatment from January 1990 to December 2000, the clinical data were retrospectively reviewed and the pathological exam was reconfirmed, the survival and the correlating factors were statistically analyzed in accordance with the follow-up.Results The overall survival rates at 1-, 3-, 5- year were 96.3%, 72.1 % and 61.9 %, respectively. The survival rate in the group of complete resection (n=63) was significantly higher than that in the group of partial resection (n=7) in which none survived over 2 years. In the complete resection group, there was no significant difference of survival rate between local resection(n=19) and tumor-bearing organ resection(n=24), whereas the extensive resection(n=20) archieved significant longer survival when compared with the previous two variety of resection. Sex, tumor size, pathology type, karyokinesis and recurrence-metastasis were correlated with survival rates in the complete resection group in monovariate analysis, but only tumor size, karyokinesis, recurrence-metastasis were correlated with survival rates by the Cox regression multivariate analysis (P<0.05). Conclusions Surgery remains the major approach for gastric GIST. Complete resection is the principal treatment. The survival cannot be improved by extensive resection and lymph nodes clearance.