基于循证医学的小胃肠间质瘤规范化诊断与治疗

Evidence-based standardized diagnosis and treatment of small gastrointestinal stromal tumors

小胃肠间质瘤(小GIST,肿瘤直径<2 cm)检出率逐渐增多。尽管大多数小GIST在临床上呈良性或惰性表现,但确有少数病例显示出侵袭性行为,甚至可能伴随复发转移。鉴别小GIST的生物学行为和恶性潜能,是规范化治疗GIST的前提。对于非胃来源小GIST,一经发现即建议切除治疗;对于胃小GIST,在没有超声内镜提示高危因素的条件下,可以选择密切随访观察;若超声内镜提示有高危因素或随访过程中直径增大者,建议切除治疗。在完整切除的基础上,尽可能地保留功能,仍然是小GIST的治疗原则。在此基础上,需谨慎地选择个体化的治疗策略。

The actual incidence of small gastrointestinal stromal tumors(GIST)increases gradually.Although the biological behavior of most of small GIST is benign or indolent,a few small GIST can develope to recurrence and metastasis with biological invasive behavior.Identification of biological behavior and malignant potential is the cornerstone of treatment.For non-gastric small GIST,surgery is always the treatment of choice.Regarding gastric small GIST,close follow-up is acceptable for patients without risk factors detected by endoscopic ultrasonography.Surgery should be suggested for those with high risks,or significant growth of tumor during follow-up.Complete resection with function preservation is the principle of surgery.Besides,individualized treatment should also be taken into consideration.