十二指肠胃肠道间质瘤外科治疗与预后因素分析

Surgical treatment for duodenal gastrointestinal stromal tumor and its prognostic factors

目的:探讨十二指肠胃肠道间质瘤的诊断、手术方式和预后因素。方法:回顾性分析18例经病理证实的十二指肠胃肠道间质瘤的临床资料,包括临床症状、诊断方法、病灶部位、手术方式、病理结果和预后等。结果:18例均行手术切除治疗,11例行十二指肠肿瘤局部切除术,3例行胰十二指肠切除术(Child术),2例行肠段切除术,2例行胃大部切除术;经24个月到7年随访,5例死于转移和复发,其余13例生存,生活质量良好。随访资料显示性别、年龄、肿瘤大小和手术方法与病人的复发和死亡率无关;导致病人复发和死亡唯一危险因素是肿瘤的危险度分级。结论:上消化道出血是十二指肠胃肠道间质瘤最为常见的症状。多因素分析显示,高危分级是十二指肠胃肠道间质瘤的独立预后因素;根据肿瘤部位和大小来决定手术方式。

Objective To investigate the diagnosis,the treatment and the prognostic factors of duodenal gastrointestinal stromal tumor（GIST）.Methods The clinical data of 18 cases with duodenal GIST were studied retrospectively.The duodenal GIST were confirmed by pathology.The clinical symptoms,diagnostic methods,tumor locations,surgical approaches,pathological results and prognosis were analyzed.Results All the 18 patients underwent surgical resections.Among them,11 cases were with local resection,3 cases with pancreaticoduodenectomy,2 cases with segmental duodenectomy and 2 cases with gastrectomy.During a follow-up of 24 months to 7 years,5 patients died of metastasis and recurrence,and the remaining 13 patients survived with a good quality of life.The follow-up data showed that the gender,age,tumor size and operative method were not significantly correlated to disease recurrence and death.The only significant predictor for disease recurrence and death was the high-risk duodenal GIST′s classification.Conclusions Upper gastrointestinal hemorrhage is commonly seen in duodenal GIST.Multivariate analysis showed that the high-risk classification is an independent prognostic factor for the duodenal GIST,and the surgical approaches were decided by the tumor location and the tumor size.