小胃肠间质瘤手术方式的选择

Option for different surgeries in treating small gastrointestinal stromal tumors

目的:探讨小胃肠道间质瘤(gastrointestinal stromal tumor,GIST)的生物学特性及不同手术方式下的复发率及并发症发生率,以协助其手术方式的选择。方法:回顾性分析中南大学湘雅医院2009年1月到2015年12月经病理科确诊为GIST且肿瘤直径<2 cm的78例原发性局限性GIST患者(共79处病灶)的临床及病理资料,并分析小GIST手术治疗的并发症发生情况及术后复发情况。结果:小GIST患者中男:女=1:1.69,初诊的中位年龄为49岁,中老年多见。病灶最多见于胃,其次是食管、小肠,结直肠最少。60.3%(47/78)患者出现腹痛腹胀,7.7%(6/78)有黑便或便血症状。98.7%(78/79)小GIST核分裂象≤5/50 HPF。免疫组织化学示CD117阳性率98.7%,CD34阳性率86.1%,DOG-1阳性率82.3%,actin-平阳性率31.6%,S-100阳性率24.1%。手术切除后共3例患者出现并发症,其中1例为内镜治疗患者,2例为传统手术治疗患者;随访过程中共2例复发,均为传统手术切除患者。传统手术治疗与内镜治疗的术后并发症发生率及复发率差异均无统计学意义(P>0.05)。结论:小GIST恶性潜能低,复发转移率低,生物学行为偏良性。传统手术治疗与内镜治疗均安全有效,但内镜治疗相对有费用较低、住院时间较短及创伤较小等优点,因此在内镜操作技术较为成熟的地方,内镜治疗不失为小GIST根治性切除的首选方法。

Objective： To explore the differences in biological characteristics for the small gastrointestinal stromal tumors and the incidence of complications and recurrence between the traditional surgical treatment and endoscopic treatment. Methods： We collected the relevant clinical and pathological data from patients who were diagnosed as gastrointestinal stromal tumors with the diameter less than 2 cm by the Department of Pathology of Xiangya Hospital from January 2009 to December 2015. Th e complications and recurrence after the surgical treatment were analyzed. Results： In patients with small gastrointestinal stromal tumors, the proportion of female was higher than that of male （male：female=1：1.69）. The median age for patient with this disease was 49 years old and it was more common in middle-aged and elderly. Most lesions were found in the stomach, followed by the esophagus and the small intestine. The small gastrointestinal stromal tumors occurred in the colon and rectum were rare. There was 60.3% （47/78） patients with abdominal pain, 7.7% （6/78） patients with hematochezia or melena, and 98.7% （78/79） with small gastrointestinal stromal tumors’ mitotic count ≤5/50 HPF. The positive rates for CD, CD34, DOG-1, actin-smooth, and S-100 were 98.7%, 86.1%, 82.3%, 31.6%, and 24.1%, respectively. Three patients occurred surgical complications, 2 suffered recurrence during the follow-up. There was no significant difference in the incidence of complications and recurrence between the traditional surgical treatment and endoscopic treatment （P〉0.05）. Conclusion： Small gastrointestinal stromal tumors’ malignant potential is low, and the recurrence and metastasis rate is low. Its biological behavior tends to be benign. The traditional surgical treatment and endoscopic treatment are both safe and effective for small gastrointestinal stromal tumor. Endoscopic treatment has the advantages in lower cost, shorter hospitalization time, and small trauma. Therefore, endoscopic treatment could be the first choice for small GIST resection under the condition of mature endoscopic technology.