胃肠间质瘤联合脏器切除22例疗效分析

Gastrointestinal stromal tumor complicated with multivisceral resection:an analysis of 22 cases

目的探讨胃肠间质瘤联合脏器切除的指征及方法。方法回顾性分析1994-2005年复旦大学附属肿瘤医院收治的22例胃肠间质瘤行联合脏器切除的病例资料。结果联合脾切除8例,结肠切除6例,肾脏切除5例,肝部分切除1例,十二指肠切除1例,卵巢切除1例,胰体尾切除3例,肾上腺切除1例,两个脏器切除3例,三个脏器切除2例,5例胃间质瘤及2例小肠间质瘤淋巴结清扫术后,未证实淋巴结转移,病理检查提示肿瘤累及肾、脾、胰、各2例,肠系膜与大网膜各1例,全组无死亡病例。随访14例,9例存活,5例因肿瘤复发转移死亡。结论胃肠间质瘤如侵犯周围脏器,联合脏器切除对病人可能有益,掌握手术指征也很重要。与靶向药物结合外科治疗胃肠间质瘤更为适合。

Objective To investigate the indication and method of gastrointestinal stromal tumor （GIST） complicated with multivisceral resection. Methods The clinical data of 22 cases of GIST complicated with multivisceral resection between 1994 and 2005 in the Cancer Hospital of Fudan University were analyzed retrospectively. Results The types of multivisceral operation included splenectomy （ n = 8 ）, coloectomy （ n = 6）, nepherectomy （ n = 5 ）, partial hepatectomy （ n = 1 ）, duodenectomy （ n = 1 ）,oophorectomy （ n = 1 ）,pancreatectomy （ n = 3）, and adrenalectomy （ n = 1 ）. Three cases were performed two adjacent organs resection, and 2 cases were performed 3 adjacent organs resection. None of lymph node metastasis was found in 7 cases with lymph node dissection with gastric stromal tumor （ n = 5 ） and small in- testinal stromal tumor （ n = 2 ）. The involved organs comfirmed by the pathology diagnosis included kidney （ n = 2 ）, spleen （ n = 2）, pancreas （ n = 2）, mesentery （ n = 1 ） and omentum （ n = 1 ）. There was no postoperative mortality in the series. Among followed up patients, 9 were survival and 5 cases were died from the tumor recurrence or metastasis. Conclusion For the cases of GIST invading the adjacent organs, muhivisceral resection could be benefit. Meanwhile, the operation indications are very important. Target drug combined with surgery may be a better method for the treatment of GIST.