腹腔镜下胃部胃肠间质瘤切除术的疗效观察

目的观察与评价腹腔镜下治疗直径小于5 cm胃部胃肠间质瘤的疗效以及安全性。方法根据手术方法不同将2010年2月至2015年5月丹东市中心医院收治的直径小于5 cm的胃部胃肠间质瘤患者分为两组,腹腔镜组16例,开腹组21例。观察与比较两组的手术时间、术中出血量、术后首次排气时间、术后进食时间以及住院时间。结果腹腔镜组手术时间[(202.82±67.57)min],术中出血量[(35.63±62.22)ml],术后首次排气时间[(3.21±1.20)d]、住院时间[(7.63±2.40)d]和术后进食时间[(4.11±1.20)d]均少(短)于开腹组的(142.27±56.32)min、(128.33±58.13)ml、(4.42±1.50)d、(10.68±2.50)d、(5.52±1.40)d(P0.05)。两组患者均完整切除肿瘤,无肿瘤破裂情况出现。腹腔镜组无术中转开腹情况。结论腹腔镜下切除直径小于5 cm的胃部胃肠间质瘤疗效安全、可靠。     

腹腔镜对比开腹手术治疗胃部胃肠间质瘤的疗效研究

摘 要：［目的］ 探讨腹腔镜对比开腹手术治疗胃胃肠间质瘤（GIST）的适应证、安全性及短期临床疗效。［方法］ 回顾性分析118例接受腹腔镜及开腹手术治疗的原发胃GIST患者的临床病理资料、手术相关数据和短期临床疗效。［结果］开腹组和腹腔镜组的手术时间分别为（96.8±34.6）min和（96.3±36.5）min,差异无统计学意义。腹腔镜组在术中出血、术后自主排气时间、术后疼痛评分、术后住院时间上均优于开腹组,差异有统计学意义（P<0.05）。全组患者均获随访,无死亡病例。两组在术后复发或转移、术后并发症方面差异无统计学意义。［结论］腹腔镜手术治疗胃GIST安全有效,患者术中出血少,术后恢复快。     

胃间质瘤的手术治疗

目的：探讨胃间质瘤合理的治疗方法。方法：回顾性分析1998／2001收治的42例胃间质瘤患者的临床资料，并进行随访。结果：42例胃间质瘤平均年龄57．4a，其中≥50a者32例，占76．2％;男女之比2：1。全组术前诊断胃肿瘤者38例(90．5％)，其中诊断为胃间质瘤(恶性)的仅l例(2．4％)。手术切除是唯一有效的治疗方法。腹腔镜下的胃间质瘤切除术是一种创伤小、出血少、恢复快的手术方法，可选择性地用于有适应证的病例：贲门部胃间质瘤的腹腔镜手术方法尚需进一步研究。随访的良性和交界性胃间质瘤在剖腹和腹腔镜手术后均无复发：恶性胃间质瘤预后极差。结论：胃间质瘤多发于老年人，以男性多见。胃间质瘤的手术切除要采取个体化的手术方案。只要适应证选择适当，腹腔镜胃间质瘤切除术与剖腹手术同样有效，而且是一种微创的手术方法。     

胃肠间质瘤47例临床分析

目的总结胃肠间质瘤的临床病理和免疫组织化学（免疫组化）特征,探讨其诊断和治疗,并评价预后。方法对2002年1月-2007年3月5年期间收治的47例胃肠间质瘤病人的临床资料进行回顾性分析,并完成随访。结果47例病人中CD117阳性40例（85．1％）,CD34阳性39例（83．0％）,S-100阳性10例（21．3％）,平滑肌肌动蛋白SMA阳性3例（6．4％）,结蛋白desmin全部阴性。结论CT结合内镜检查可提高诊断率,最终确诊主要依靠病理及免疫组化,CD117是诊断GIST的重要标记物,手术完整切除肿瘤效果满意．恶性GIST宜行较大范围的切除术,必要时须行联合脏器切除。     

腹腔镜手术与开腹手术治疗胃间质瘤51例临床分析

目的：比较胃间质瘤腹腔镜手术与开腹手术的临床疗效, 探讨腹腔镜技术在胃间质瘤治疗中的应用价值。方法： 2009年1月至2010年11月间, 中国医科大学附属盛京医院收治胃间质瘤患者51例, 其中腹腔镜手术32例, 开腹手术19例, 分析2组患者临床资料, 对比手术时间, 术中出血量, 术后排气时间, 进食时间, 住院天数, 随访结果。结果： 腹腔镜组手术时间为65.5±9.8min, 与开腹组66.7±10.7 min比较无显著性差异, 术中出血量49.7±7.5 mL, 明显少于开腹组148.8±22.3 mL, 术后排气时间24.8±3.7 h少于开腹组34.7±5.6 h, 住院时间6.3±1.1 d短于开腹组8.9±1.4 d, 短期随访1～25个月, 无复发。结论： 腹腔镜胃间质瘤手术安全、 有效, 具有可行性。     

31例胃肠间质瘤临床分析

[目的]探讨胃肠间质瘤的临床诊断、治疗和预后。[方法]回顾性分析31例胃肠间质瘤临床和病理资料。[结果]根据Fletcher风险分级，极低风险3例，低风险5例，中风险15例，高风险8例。CD117、CD34、Desmin、SMA、S-100蛋白阳性表达率分别为94％、87％、39％、35％、26％，其阳性表达率与肿瘤危险程度无关（P〉0．05）。肿瘤是否浸润黏膜肌层或浆膜层与肿瘤危险程度相关（P〈0．05）。中、高风险程度者复发率26．0％．明显高于极低和低风险者（P〈0．001）。[结论]用Fletcher分级对胃肠间质瘤分级评价更为科学合理。肿瘤浸润黏膜肌层或浆膜层是肿瘤危险的重要指标。     

从腹部外科医师的角度审视食管胃结合部胃肠间质瘤微创治疗策略的演变发展趋势

胃肠间质瘤(gastrointestinal stromal tumor,GIST)是胃肠道最常见的间叶源性肿瘤,近年来微创治疗技术已经被越来越多地应用于GIST的治疗.食管胃结合部GIST的外科治疗具有一定的特殊性,临床医师需要提高对食管胃结合部GIST的认识,并制订最优化的治疗手段.本文拟从腹部外科医师视角浅析基于...     

胃肠间质瘤的治疗进展

作为胃肠道最常见的一类间叶源性肿瘤,胃肠间质瘤（GIST）越来越受到关注。近10年来,随着对GIST分子机制研究的深入,以伊马替尼为代表的分子靶向药物的出现,改变了GIST的传统治疗理念,形成了外科手术联合分子靶向药物的治疗模式。靶向药物在GIST的术前、术后辅助治疗及晚期GIST中的应用显著改善了患者的预后,延长了生存时间。但是,针对不同期别的GIST,应该如何合理应用这些靶向药物,临床还有很多问题亟待解决。本文就GIST的围手术期治疗及晚期GIST治疗的最新进展作一综述。     

Hand-assisted laparoscopic surgery for a large gastrointestinal stromal tumor of the stomach

We report two cases of large gastrointestinal stromal tumor (GIST) of the stomach that were successfully treated by hand-assisted laparoscopic surgery (HALS). Two patients, a 56-year-old woman and a 60-year-old man, were admitted to our department for the treatment of a large submucosal tumor of the stomach. After gastrointestinal endoscopy, ultrasonography, computed tomography, and magnetic resonance imaging, we suspected that the masses, measuring 7.0 cm and 8.0 cm in diameter, respectively, were GISTs in the stomach. However, preoperatively, we could not rule out the possibility of malignant neoplasms, because they had been bleeding or gradually growing. Hand-assisted laparoscopic wedge resection was safely performed for the diagnosis and treatment of the submucosal tumor of the stomach. The immunohistochemical diagnosis in both patients was GIST of the stomach with intermediate-grade malignancy. HALS may be a good indication for large GISTs of the stomach that are difficult to diagnose preoperatively, whether they are malignant or benign, because it is safe and minimally invasive, promoting rapid recovery.     

直肠间质瘤11例诊治分析

目的：探讨位于直肠的胃肠间质瘤的临床特点、诊断及治疗方法。方法：对我院1995年1月～2005年12月间收治的11例直肠间质瘤的临床资料、病理及治疗进行回顾性分析。结果：11例均经手术及病理确诊,免疫组化检测CDll7、CD34阳性率分别为100％、72．7％,其临床表现无特异性。术前考虑为GIST者3例（27．3％）,本组均经手术治疗,行Dixon术6例,Miles术3例,局部切除2例。经随访18～150个月,死亡2例,其余9例均存活且无复发。结论：直肠间质瘤临床少见,生物学行为多变,具有潜在恶性,手术是唯一能治愈的方法,根治性切除较局部切除效果好。     

42例胃肠道间质肿瘤的临床病理形态观察

目的：研究国人胃肠道间质肿瘤（gastrointe stinal stromal tumor,GIST）的临床病理形态特点。方法：应用光镜观察42例GIST的形态特征,用免疫组化S-P法检测CD117、CD34、SMA及S-100蛋白在GIST中的表达情况。结果：GIST的瘤细胞排列成交织束状、弥散片状、栅栏状或轮辐状,较为特征的是细胞团巢形成;胞质嗜酸性较经典的平滑肌瘤者为弱。瘤细胞为梭形或上皮样,或梭形与上皮样细胞混合存在。CD117和CD34的阳性率为92．9％（39／42）和76．2％（32／42）。结论：GIST是胃肠道最常见的间叶性肿瘤,有较为独特的组织学形态,CD117和CD34标记阳性是确诊GIST最有价值的诊断依据。     

Resection of residual disease in patients with metastatic gastrointestinal stromal tumors responding to treatment with imatinib

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. Long-term survival of patients with metastatic disease has only been observed in patients with completely resected disease. Recently, the tyrosine kinase inhibitor imatinib has been found to yield responses in the majority of patients with metastatic GIST suggesting improved resectability in responding patients. Combined treatment approaches including resective surgery after imatinib treatment in patients with advanced metastatic disease have rarely been explored. We report a series of 90 patients with metastatic GIST in whom treatment with imatinib enabled 12 patients with mostly recurrent and extensive disease to be considered for resection of residual disease. In 11 of these patients, complete resection could be achieved. Viable tumor cells were found in all but one resected specimens suggesting that despite favorable radiological or clinical responses, imatinib is unlikely to induce pathological complete responses. Until more mature data from prospective trials are available, these data suggest that an early aggressive surgical approach should be considered for all patients with metastatic GIST. Further trials investigating a combined surgical and pre/postoperative treatment with imatinib in patients with advanced metastatic GIST are warranted.     

十二指肠间质瘤:上消化道出血原因之一(英文)

Objective:The aim of the study was to report an anemia patient with melena for five years caused by duodenal gastrointestinal stromal tumor (GIST), who required surgical treatment. Methods: A 44-year old man present with anemia appearance was admitted to our center (Department of Hepatobiliary Surgery, Union Hospital, Huazhong University of Science and Technology, China) due to sustaining melena for five years. Endoscopy found no special mucosal abnormalities in the duodenal lumen. Computed Tomography showe...     

Tumor mitotic rate, size, and location independently predict recurrence after resection of primary gastrointestinal stromal tumor (GIST)

BACKGROUND: Gastrointestinal stromal tumor (GIST) is the most frequent sarcoma of the intestinal tract and often shows constitutive activation of either the KIT or PDGFRA receptor tyrosine kinases because of gain-of-function mutation. Although the efficacy of tyrosine kinase inhibitors in metastatic GIST depends on tumor mutation status, there have been conflicting reports on the prognostic importance of KIT mutation in primary GIST. METHODS: A total of 127 patients were studied who presented to our institution from 1983 to 2002 with localized primary GIST and underwent complete gross surgical resection of disease. The majority of tumors originated in the stomach (58%) or small intestine (28%). By using polymerase chain reaction (PCR) and direct sequencing, a KIT mutation was found in 71% of patients and a PDGFRA mutation in 6%. RESULTS: After a median follow-up of 4.7 years, recurrence-free survival was 83%, 75%, and 63% at 1, 2, and 5 years, respectively. On multivariate analysis recurrence was predicted by > or =5 mitoses/50 high-power fields, tumor size > or =10 cm, and tumor location (with patients having small bowel GIST doing the worst). In particular, a high mitotic rate conferred a hazard rate of 14.6 (95% confidence interval, 6.5-32.4). Specific KIT mutations had prognostic importance by univariate but not multivariate analysis. Patients with KIT exon 11 point mutations and insertions had a favorable prognosis. Those with KIT exon 9 mutations or KIT exon 11 deletions involving amino acid W557 and/or K558 had a higher rate of recurrence, whereas patients without a tyrosine kinase mutation had intermediate outcome. CONCLUSIONS: In the absence of therapy with tyrosine kinase inhibitors, recurrence in completely resected primary GIST is independently predicted by mitotic rate, tumor size, and tumor location.     

Totally laparoscopic resection for a large gastrointestinal stromal tumor of stomach

A debate is currently ongoing about whether a large gastrointestinal stromal tumor (GIST) should be treated by the laparoscopic approach because of the increased risk of tumor rupture during manipulation of the tumor with laparoscopic instruments and the resultant peritoneal tumor dissemination. Herein, we report a case of a large GIST of the stomach which was successfully treated by the laparoscopic approach. A 57 year old female patient visited our institution complaining of postprandial epigastric discomfort. An esophagogastroduodenoscopy and an abdominal computed tomography scan revealed a 10×8 cm sized submucosal tumor at the greater curvature side of the gastric antrum. The patient underwent laparoscopic distal gastrectomy with intracorporeal Billroth-II reconstruction without any breakage of the tumor. Her postoperative course was uneventful and she was discharged on the 7th postoperative day. Even a large GIST of the stomach can safely be treated by the laparoscopic approach when it is performed with proper techniques by an experienced surgeon.     

甲磺酸伊马替尼治疗胃肠道间质瘤的研究进展

胃肠道间质瘤（GIST）是胃肠道及腹腔最常见的间叶源性肿瘤,对常规的放疗、化疗均不敏感。外科手术是局限性GIST患者的主要治疗方式,但术后复发率较高。对于术前、术后辅助、复发、转移及不能手术切除的患者,酪氨酸激酶抑制剂甲磺酸伊马替尼对其有较好的治疗效果。本文对甲磺酸伊马替尼治疗胃肠道间质瘤的研究进展作一综述。