胃肠道间质瘤患者行急诊手术的临床及预后分析

Clinical and Prognostic Analysis of Emergency Operation in Patients with Gastrointestinal Stromal Tumor

目的比较胃肠道间质瘤(GIST)患者行急诊手术治疗与择期手术治疗的临床参数及预后。方法回顾性分析中国医科大学附属第一医院急诊科2010年9月至2018年3月期间诊断为GIST并行急诊手术治疗的患者(急诊手术组,30例)与行非急诊手术患者(非急诊手术组,154例)的临床资料。分析2组患者的一般情况、临床病理参数、术后治疗,比较复发及生存情况。结果2组患者在术前是否合并出血、中性粒细胞计数、淋巴细胞计数、原发肿瘤部位方面有统计学差异(P<0.05);急诊手术组的复发时间及生存时间均小于非急诊手术组,差异有统计学意义(P<0.05);单因素及多因素分析结果显示,可能影响患者术后生存的因素包括肿瘤直径>5 cm,核分裂像>5/高倍镜视野,原发肿瘤非胃来源及行急诊手术(P<0.05)。结论GIST患者急诊手术可能预后不良。应提高患者术后危险分层等级,降低术后靶向治疗的准入标准。

Objective To compare the clinical parameters and prognosis of emergency and non-emergency operations for gastrointestinal stromal tumors(GIST).Methods Retrospective analysis of clinical data of 30 cases with emergency and 154 cases with non-emergency operations for the treatment of GIST was performed with follow-up of recurrence and survival data.Patients were divided into emergency and non-emergency groups.The general condition,clinicopathological parameters,recurrence,and survival in the two groups were analyzed.Results The two groups differed significantly in preoperative bleeding,neutrophil count,lymphocyte count,and primary tumor site.The recurrence rate and survival time in the emergency group were less than those in the non-emergency group.Univariate and multivariate analyses revealed that,tumor diameter greater than 5 cm,mitotic image of more than 5 per high power field 50 folds magnification,non-gastric origin,and emergency surgery to be the factors that might affect post-operative survival of patients.Conclusion GIST patients undergoing emergency operation may have poor prognosis.Therefore,there is a need to improve the postoperative risk stratification of such patients.