胃平滑肌肉瘤的诊治体会

Diagnosis and treatment of gastric leiomyosarcoma

目的总结我院治疗胃平滑肌肉瘤 (GLS)的临床经验 ,以提高对本病的认识和疗效 .方法回顾性分析本院 33年来收治的 GLS 21例的临床资料 ,生存过程描述采用 Kaplan- Meier生存曲线法 .结果本组 GLS以上腹胀痛不适、上消化道出血及腹部肿块为主要临床表现 ,其中以上消化道出血尤为突出 .本组肿瘤全切除的 12例患者 5年、 10年生存率为 67%和 50% ,肿瘤不全切除的 8例患者仅 2例生存了 5年 , 10年生存率为 0,本组总的 5年、 10年生存率为 47%和 37% .结论 GLS是胃部常见非上皮性恶性肿瘤 ,但临床极易误诊 ,故应提高警惕 ,综合分析 ,才能提高本病的诊断率 .为了提高生存率和生存质量 ,对原发肿瘤主张肿瘤全切除 ,对术后的复发灶和转移灶 ,主张积极的再切除 ,但不主张行扩大的淋巴结清除术 .

Objective To summarize the experience of surgical treatment of gastric leiomyosarcoma(GLS) , in order to gain more knowledge of GLS and to increase the level of diagnosis and treatment.Methods Clinical and pathologic data from 21 patients with GLS treated from 1964 to 1997 were reviewed and analyzed. The survival rate was described by Kaplan- Meier method.Results The most common signs and symptoms were abdominal pain (76% ), gastric bleeding (57% ), and abdominal mass (52% ). Among these, the presentation of gastric bleeding was prominent. In this series, twelve patients were treated by complete tumor excision, the 5- ,10- year survival rate was 67% and 50% ; eight patients were treated by partial excision, and only 2 cases survived for 5 years, the 10- year survival rate was zero; and the overall 5- ,10- year survival rate was 47% and 37% .Conclusions GLS is common unepithelial malignant tumor of stomach and easily misdiagnosed. In order to increase its diagnosis rate, the caution for GLS should be kept, and the comprehension should be applied. To improve the survival rate and quality of life, the primary tumor should be excised completely, postoperative recurrent lesion and metastatic lesion should be re- excised actively, but the extended lymph- dissection is not recommended.