低位直肠间质瘤治疗策略分析

The analysis of low rectal stromal tumor treatment strategy

目的探讨低位直肠间质瘤的临床特征及治疗方法。方法回顾性分析32例接受手术治疗的低位直肠间质瘤病人的临床资料,按手术方法分为两组。接受Dixon及Miles手术的为扩大手术组,接受内镜下切除、经肛切除,经骶切除及经会阴切除者,为局部切除组。其中扩大切除组14例,局部切除组18例,比较两组的临床特征及术后复发转移情况。结果扩大切除组的手术时间是(152. 4±46. 2)分钟,出血量是(76. 1±36. 6) ml,肛门排气时间(3. 8±0. 6)天,住院时间(10. 2±1. 6)天;局部切除组分别是(54. 1±17. 9)分钟,(41. 1±20. 3) ml,(2. 9±0. 8)天和(6. 3±1. 3)天,两组比较差异均有统计学意义(P <0. 05)。两组间手术并发症,术后局部复发及远处转移比较,差异无统计学意义(P> 0. 05)。结论低位直肠间质瘤采用局部切除联合伊马替尼治疗未增加局部复发及远处转移的风险,但手术时间,出血量,住院时间显著降低,局部切除联合伊马替尼能明显减少创伤及改善病人生活质量。

Objective To study the clinical characteristics and treatment methods of the low rectal stromal tumor. Methods The clinical and follow-up data of 32 patients with low rectal gastrointestinal stromal tumor( GIST) were analysed. Paitents with Dixon and Miles operation were called group expanded resection( 14 cases),and patients with endoscopic resection,trans-anal,trans-sacral,trans-perineum resection were called group local resection( 18 cases). Compared the two groups with clinical characteristics and postoperative recurrence or metastasis. Results Operation time of group expanded resection was( 152. 4 ± 46. 2) min,while group local resection was( 54. 1 ± 17. 9) min,the blood loss of the two group was( 76. 1 ± 36. 6) ml and( 41. 1 ± 20. 3) ml,respectively;anus exhausting time of the two group was( 3. 8 ± 0. 6) d and( 2. 9 ± 0. 8) d,respectively;hospital stay of the two group was( 10. 2 ± 1. 6) d and( 6. 3 ± 1. 3) d,respectively( all P < 0. 05). There was no significant difference such as surgical complications,local recurrence and distant metastasis between the two groups. Conclusion Low rectal stromal tumor treated by local excision and imatinib did not increase the risk of local recurrence and distant metastasis,but the operation time,blood loss,hospitalization days significantly reduced,It is a safe and effective strategy to low rectal stromal tumor.