摘要
目的：探讨胃平滑肌肿瘤（ＧＳＭＴ）的临床表现、诊断与合理的手术治疗。方法：回顾分析３２例胃平滑肌肿瘤（ＧＳＭＴ）的临床治疗及随访资料。结果：胃平滑肌瘤１７例均手术局部切除；平滑肌肉瘤１４例，其中８例行胃大部切除，２例行全胃切除，２例姑息切除。２例探查造瘘，１例上皮样平滑肌瘤行胃大部切除。首发症状表现为上消化道出血。术前内镜ＧＩ、ＣＴ等联合检查，阳性诊断率为 ８４．６１％，手术切除率为 ９３．８％。胃平滑肌恶性肿瘤为非淋巴途径转移，５年生存率６４．３％。结论：胃平滑肌肿瘤直径＞ ５ｃｍ多为恶性，且对放化疗均不敏感，术前胃镜、ＣＴ检查具有较强特异性。手术切除为唯一有效治疗手段，对转移和复发灶也应积极手术并定期长期随访。
Objective: To discuss the diagnosis and surgical treatment of smooth muscle tumors of the stomach. Methods: Clinical and follow - up survey data of 32 cases of gastric smooth muscle tumors were analyzed retrospectively. Results: Leiomyomas in 17 cases were resected. In 14 cases of leiomyosarcoma, 8 were undergone subtotal gastrectomy, 2 were treated with total gastrectomy, 2 were palliatively resected, another 2 cases underwent gastrostomy. One case of epithelioid leiomyoma was treated with subtotal gastrectomy. The most common presenting symptom in the cases was upper gastointestinal hemorrhage. 84. 61 % of the tumors were diagnosed preoperatively by combined gastric endoscopy, GI serials and CT 93. 8 % of the tumors were resectable. A nonlymphatic way was adopted in the metastasis of malignant gastric smooth muscle tumors, and the 5 - year survival rate was 64. 3 %. Conclusion: Gastric smooth muscle tumors larger than 5 cm strongly tend to be malignant. Preoperative combined examination of gastric endoscopy and CT contribute to the diagnosis of the disease with a relatively high specificity, and surgery is the best choice of the treatment. For malignant tumors with metastasis and recurrence active operation and tong time follow - up survey are needed.
