十二指肠胃肠间质瘤外科手术36例病例报道

Surgical treatment of duodenal stromal tumors: a report of 36 cases

目的总结十二指肠胃肠间质瘤(GIST,gastrointestinal stromal tumor))外科手术处理的临床效果。方法回顾性分析在2002年03月~2018年05月间深圳市人民医院收治的39例十二指肠GIST病例,其中36例行外科手术治疗,并对术后恢复情况进行分析。结果14例行十二指肠肿瘤局部切除术,7例行十二指肠楔形切除、端端吻合术;7例行肠段切除、十二指肠空肠R-y吻合,2例行胃大部切除、胃空肠吻合术,5例行胰十二指肠切除术,1例行单纯胃空肠吻合短路手术。术后死亡1例,术后发生吻合瘘3例,腹腔出血1例,切口感染5例。结论十二指肠GIST局部切除手术安全,胰十二指肠切除手术创伤大,并发症多,应谨慎采用,中高危患者术后需辅助靶向治疗。

Objective To summarize the clinical effect of surgical operation for duodenal gastrointestinal stromal tumor(GIST).Methods Retrospective analysis was made of 39 cases of duodenal GIST admitted to Shenzhen People's Hospital from March 2002 to May 2018.Clinical data of 39 cases of duodenal GIST between March 2002 and May 2018 was analyzed.36 patients underwent surgical operation.Results In 36 patients,14 cases received duodenal lesion excision and primary closure;7 cases wedge resection of the lesion and end to end duodenoduodenostomy;7 cases segmental duodenectomy with Roux-en Y duodenojejunostomy;2 cases segmental duodenectomy and gastrojejunostomy;5 cases pancreatoduedenectomy;1 case gastrojejunostomy only.1 case died,3 cases anastomotic fistula,1 case abdominal bleeding,5 cases wound infection.Postoperative follow up of 31 cases.Conclusion Lesion resection for duodenal GIST is safer.With higher postoperative morbidity and mortality,pancreatoduedenectomy should be carried out cautiously.High and intermediate risk Patients should be received postoperative adjuvant targeting therapy.