胃肠道间质瘤的外科治疗

Surgical treatment for patients with gastrointestinal stromal tumor

目的 分析胃肠道间质瘤(gastrointestinal stromal tumor,GIST)外科治疗效果以及影响手术疗效的因素。方法 对我院1990年1月至2003年5月外科治疗的97例GIST患者的临床资料和病理切片(含免疫组织化学检查)重新复核并对患者进行随访。结果 本组中位生存时间为57.3个月,完全切除术组患者生存率明显优于不完全切除术组(P=0.00),后者无1例生存期超过2年。完全切除术组中,肿瘤局部切除和肿瘤及所在器官切除患者生存率之间比较,差异无显著性意义(P=0.2795);但肿瘤局部切除和肿瘤及所在器官切除两组分别与扩大切除术组比较,差异却有显著性意义(P=0.00)。完全切除术患者的生存率与其性别、肿瘤部位和大小、肿瘤性质、核分裂及复发转移有关;但多因素的Cox回归分析显示,其术后生存率仅与肿瘤大小、肿瘤性质和复发转移相关。结论 GIST以外科治疗为主,原则上施行局部完全切除即可,广泛切除或扩大淋巴结清扫不能提高其生存率。

Objective To analyze the operative outcomes of the patients with gastrointestinal stromal tumors(GISTs) and their offecting factors. Methods The clinical and pathological data including immunohistochemical results of 97 patients with GISTs from 1990 to May 2003 were collected, and the operative outcomes and survival were analyzed retrospectively. Results The overall 1-, 2-, 3-, 4- and S-year survival rates were 100%, 85.3%, 75.3%, 67.3% and 48.1%, respectively. In complete resection group, the median survival time was 58.3 months, and the 3 and S-year survival rates were 79.9% and 51.0% respectively. The median survival time in incomplete resection group was 21.8 months, and none of these patients survived more than 2 years. There was no significant difference in survival rate between local complete resection group and tumor-loading organ resection group, but the survival of both the above groups were better than that of extended resection group. Univariate analysis revealed sex, tumor site and size, pathological type, karyokinesis, recurrence and metastasis were correlated with the survival rates of the patients with tumor completely resected. Multivariate analysis revealed only tumor size, pathology type, recurrence and metastasis were independent prognostic factors. Conclusions Surgery is still the main treatment for GISTs. Local complete resection is the principal treatment. The survival cannot be improved by extended resection and lymph nodes clearance.