胃间质瘤的手术治疗

Surgical Resection of Gastric Stromal Tumors

目的探讨胃间质瘤的手术治疗方法及临床病理特点.方法回顾性分析经手术治疗的78例胃间质瘤患者的临床和病理资料,其中男34例,女44例.手术完全切除76例,其中胃楔形切除39例,远端胃大部切除术17例,近端胃大部切除术20例;姑息性切除2例.结果肿瘤平均直径5.5 cm,其中＜5 cm者39例,5～10 cm者27例,＞10 cm者12例.病变位于胃窦部12例,胃体部30例,胃底部36例.胃周淋巴结转移2例(2.6%).免疫组化结果:CD117阳性74例(94.9%),CD34阳性61例(78.2%),SMA阳性29例(37.2%),Desmin阳性8例(10.3%),S-100阳性8例(10.3%).72例(92.3%)获随访,平均56.1(3～168)个月,术后5年生存率为70.3%,术后复发转移11例(15.3%),术后复发转移者再次手术治疗6例,再次手术切除可延长患者生命.结论胃间质瘤的治疗以手术为主,术中应注意完整切除和防止肿瘤破裂.

Objective To investigate the clinic pathological features and surgical access for gastric stromal tumor(GST). Methods Seventy eight cases of GST underwent surgical treatment were retrospectively reviewed in terms of clinical and pathological features. 34 male and 44 female were included, in which 76 cases underwent radical resection, including 39 cases of wedge resection, 17 cases of distal subtotal gastrectomy, and 20 cases of proximal subtotal gastrectomy. The rest 2 cases underwent palliative resection. Result Average diameter of tumor was 5.5 cm, including 39 cases less than 5 cm, 27 cases between 5 to 10 cm, 12 cases over 10 cm. The locations were gastric antrum in 12 cases, gastric body in 30 cases and gastric fundus in 36 cases. 2 cases had perigastric lymph note metastasis (2.6%). Immunohistochemistry staining showed CD117 positive in 74 cases(94.9%), CD34 positive in 61 cases(78.2%), SMA positive in 29 cases(37.2%), Desmin positive in 8 cases(10.3%), S-100 positive in 8 cases(10.36%). 5-year survival rate was 70.3% with 3 to 168 months(mean 56.1 months) follow-up in 72 cases. Recurrence occurred in 11 cases(15.3%), of which 6 cases underwent reoperation. Conclusion Resection remains the major treatment of GST, complete excision and prevention of tumor rupture should be focused on during the operation.