胃间质瘤27例的诊治分析

Diagnosis and treatment for gastric stromal tumors:report of 27 cases

目的分析胃间质瘤的临床诊治特点。方法对南京军区福州总医院和福建省长乐市第二医院收治的27例胃间质瘤患者均经手术治疗。结果首发症状中黑便15例(其中3例伴呕血);上腹疼痛、不适伴恶心、泛酸8例;腹胀、纳差4例。14例行胃镜检查时发现胃肿物(性质待查);5例胃镜活检为胃平滑肌瘤;3例胃镜活检为胃神经纤维瘤;2例胃镜活检为胃息肉;3例经胃镜活检病理检查及免疫组化证实为胃间质瘤。全部患者均经手术治疗,切除标本经病理检查及免疫组化证实,其中19例行胃大部切除术(其中4例行近端胃大部切除加幽门成形术,15例行远端胃大部切除术),1例多发肿瘤行全胃切除术,7例行病灶楔形切除术。术后均存活,随访6个月至3年。结论胃间质瘤诊断依赖于病理检查及免疫组化,手术切除为主要治疗方法。

Objective To study the diagnosis and treatment features of gastric stromal tumors. Methods Twenty-seven cases of gastric stromal tumors from 2003 to 2006 in Changle No. 2 Hospital and Fuzhou General Hospital were reviewed. Results The most common symptom was melena in fifteen cases（including three cases of hematemesis）, upper abdominal pain with nausea and regurgitation occurred in eight cases,and abdominal distention in four cases. Under gastroscopy, fourteen cases of gastric mass, five of gastric leimyosarcoma,three of gastric neurofibrosarcoma,two of gastric polyp,and three of gastric stromal tumors were detected. All the twenty-seven cases underwent surgical operation and were confirmed by phathological examination and immunohistochemistry. Partial gastrectomy was performed in nineteen cases（including proximal partial gastrectomy and pyloroplasty in four cases,and distal partial gastrectomy in fifteen cases） ,total gastrectomy in one case of multiple tumor,local wedgy resection in seven cases. All the cases survived after operation, and were followed up from six months to three years. Conclusion The diagnosis of the gastric stromal tumors depends on phathological examination and immunohistochemistry, and surgical operation is the main choice of therapy.