胃肠道间质瘤的诊断及外科治疗体会

目的分析胃肠道间质瘤（GIST）的临床特征及手术方式。方法回顾性分析2001年1月至2005年12月经手术病理证实的GIST47例资料。结果肿瘤发生于胃部18例，十二指肠8例，小肠19例，直肠2例。4例因肿瘤广泛转移行姑息性切除，1例直肠GIST经肛门切除，其余42例均达到外科根治性切除，其中行受累脏器局部切除4例，大部切除26例，多脏器切除12例。术后平均随访20个月，术后复发和转移9例，复发问期平均为13个月。其中8例行再次手术治疗，1例再复发后行3次手术治疗。本组无手术死亡病例，术后并发细菌性腹膜炎1例，切口裂开1例，均治愈。结论外科手术是GIST治疗的首选，对复发病例仍应争取再手术治疗。

The diagnosis and surgical treatment of gastrointestinal stromal tumors (GIST)

Objective To analyze the clinical characteristics and surgical procedures of gastrointestinal stromal tumors (GIST).Methods In this study 47 cases with pathologically proved GIST were retrospectively analyzed at our hospital from January 2001 to December 2005.Results The tumours originated respectively from the stomach (n=18),the duodenum (n=8),the intestine (n=19),and the rectum (n=2).Four cases underwent palliative resection because of extensive metastasis.The GIST was resected per anum in one case.Forty-two cases received curative resection including multivisceral resection in 12 cases.Postoperative recurrence or metastasis of GIST was found in 9 caese (21.43%) during an average followed up of 20 mos with the average latency of 13 mos.Eight recurrent cases received re- operation,including repeated resection for three times in one case because of palindromia.There was no operative mortality.One case was complicated with bacterial peritonitis,and one case with wound dehiscence.Conclusions Curative-intent resection is the treatment of choice for GIST.Reoperation may prolong the survival of patients with GIST who suffered from postoperative recurrence.