胃神经源性肿瘤的诊断与外科治疗

Diagnosis and surgery treatment of gastric neurogeulc tumors

目的总结胃神经源性肿瘤的临床特点和诊治方法，提高对这一罕见疾病的认识。方法回顾分析11例经手术、病理及免疫组织化学检查证实的胃神经源性肿瘤患者的临床资料。结果本组男7例，女4例，平均55．5岁。临床主要表现为原因不明的上消化道出血、腹痛、上腹部不适和贫血。术前有9例进行了胃镜及活组织检查，其中仅1例确诊；2例行胃癌手术时发现，误诊率90．9％。全组患者均行外科手术切除肿瘤，其中胃远端大部切除术6例，胃部分切除术3例，胃近端大部切除术2例。全部患者术后均获随访，1例术后并发呼吸衰竭死亡，2例死于术后复发，其余患者预后均较好。结论胃神经源性肿瘤术前缺乏特征性的临床表现，诊断困难、误诊率高，一经确诊应及早手术治疗。

Objective To summarize the clinical characteristics, diagnosis and treatment of gastric neurogenic tumors. Methods Clinical data of 11 patients with gastric neurogenic tumors confirmed by pathology, operation and immunohistocbemistry were analysed retrospectively. Results There were 7 males and 4 females with a median age of 55.5 years. The main manifestations were gastrointestinal hemorrhage, abdominal pain, upper abdominal discomfort and anaemia. Nine patients underwent gastroscopy and only one case was confirmed by the examination. Two patients were diagnosed during operation. Eight patients were submitted to subtotal gastrectomy, three were partial gastrectomy. All patients were followed up, and perioperative death occurred in one patient because of respiratory failure, recurrence occurred in two patients. Other patients with long-term follow-up had a good prognosis. Conclusions Gastric neurogenic tumors have no specific clinical characteristics preoperatively, and the misdiagnosis rate is high. Once the diagnosis of gastric neurogenic tumors is made, an operation should be performed as early as possible.