胃间质瘤临床病理及预后分析

目的探讨胃间质瘤临床病理特征及与预后相关的因素。方法收集中国医学科学院肿瘤医院1986年3月至2001年12月收治的98例有完整资料的位于胃的间质瘤、平滑肌瘤、平滑肌肉瘤、平滑肌母细胞瘤、许旺细胞瘤和神经纤维瘤患者的临床和病理资料.复阅切片(苏木精-伊红染色)、重新诊断,肿瘤两点取材构建组织微阵列;免疫组织化学染色检测CD117、CD34、平滑肌肌动蛋白(SMA)、desmin、S-100及Ki-67蛋白等6种抗体的表达;单因素及多因素分析各变量与患者预后的关系。结果确诊间质瘤91例(92.9%)。随访率91.0%,中位随访时间54个月,患者1、5、10年生存率分别为88.8%、79.6%和63.7%。单因素分析显示,患者的预后与肿瘤大小、核分裂像数目、肿瘤坏死、核异型、细胞类型、细胞密集程度、手术类型、黏膜侵犯、年龄及Ki-67标记指数(5%为界)等因素有关(P<0.05,P<0.01);多因素分析显示,肿瘤大小、核分裂像数目、肿瘤坏死及黏膜受侵是影响预后的重要因素(P<0.05,P<0.01)。结论肿瘤直径大于10cm、核分裂像数目超过10个/50HPF、肿瘤有坏死,黏膜受侵常提示胃间质瘤恶性度较高。     

胃间质瘤的早期诊断及微创治疗

目的:探讨胃镜、超声内镜、腹腔镜联合诊治胃间质瘤(直径<5cm)的作用和价值.方法:2004年8月至2010年12月为87例胃镜发现的胃粘膜下隆起性病变患者进行超声内镜检查,初步诊断胃间质瘤41例,直径0.75～4.25cm,平均2.42cm.其中起源于粘膜肌层8例,行内镜粘膜下剥离术(endoscopic submu...     

双镜联合手术治疗胃间质瘤39例

目的：探讨腹腔镜联合胃镜（双镜联合）手术治疗胃间质瘤的临床方法及效果。方法：胃间质瘤患者39例,瘤体直径1.0～4.5cm,平均（2.5±0.5）cm,均采用双镜联合方法手术切除。手术过程：胃镜下确定胃间质瘤的位置、大小,评估切除可能性及方法,腹腔镜下切除肿瘤,闭合切口,取出肿瘤,完成手术。术后接受免疫组织化学检查和肿瘤生物学风险评估,随访复发或转移情况。结果：1例因瘤体过大予以中转开放手术。余38例手术时间35～125min,平均（75±25）min。术中出血10～50mL,平均（25±10）mL;胃管留置时间0～24h,肠道功能恢复时间12～36h,绝对卧床12～24h,术后72～96h恢复流质饮食,术后平均住院5～7d。免疫组织化学结果：CD117阳性36例（92.3%）、CD34阳性32例（82.0%）;肿瘤生物学风险分级：极低危27例,低危10例,中危2例,高危0例。随访1～42个月,未发现种植或转移。结论：双镜联合手术治疗胃间质瘤具有快速定位、优化手术流程、术时短、创伤小、恢复快、安全有效等优点,适合于直径〈5cm、术中仅靠腹腔镜难以定位的瘤灶。手术对瘤体定位、手术组成员配合要求较高,需要富有经验的医师操作。     

双镜联合治疗胃间质瘤的预后及安全性分析

目的分析双镜联合治疗胃间质瘤的预后及安全性。方法回顾性队列研究2014年3月至2017年10月119例胃间质瘤患者临床资料,根据术式不同分为联合组(n=56例,胃镜联合腹腔镜)、腹腔镜组(n=63例)。采用SPSS 23.0软件进行数据处理,围手术期指标等计量资料以(x±s)表示,采用独立样本t检验;术后恶性潜能分级、核分裂像、并发症发生率采用χ² 检验;生存率采用Kaplan-meier法检验。P<0.05为差异有统计学意义。结果联合组手术时间、术中出血量比腹腔镜组低(P<0.05);联合组术后并发症总发生率(3.6%)比腹腔镜组(15.9%)低(P<0.05);两组患者术后首次排气时间、首次排便时间、住院时间、术后恶性潜能分级及核分裂像结果、术后2年生存率相比,差异均无统计学意义(P>0.05)o结论腹腔镜及双镜联合切除胃间质瘤,患者术后生存率相当,但双镜联合治疗胃间质瘤具有快速定位、出血量少、手术时间短、并发症少等优势。     

腹腔镜手术治疗胃间质瘤的疗效分析

目的:探讨腹腔镜手术治疗胃间质瘤的可行性及临床应用价值。方法:回顾分析2011年6月至2014年9月腹腔镜治疗胃间质瘤43例患者的临床资料。结果:1例发生肿瘤破裂、1例切口感染。无中转开腹及围手术期死亡病例,均未发生明显胃出血、吻合口狭窄、胃瘫及吻合口漏等严重并发症。其中腹腔镜胃楔形切除术21例,腹腔镜经胃肿瘤外翻切除术15例,腹腔镜辅助远端胃大部切除术4例,腹腔镜辅助近端胃大部切除术3例。手术时间50~192 min,平均(85.3±53.6)min;术中出血量20~150 ml,平均(80.6±42.3)ml;术后住院7~15 d,平均(9.1±4.7)d。肿瘤直径2.0~6.3 cm,平均(3.6±2.9)cm,切缘均阴性。免疫组化染色提示:CD117阳性41例,CD34阳性36例,DOG-1阳性42例。Fletcher风险分级:极低复发危险25例,低度复发危险13例,中度复发危险4例,高度复发危险1例。术后随访10~49个月,1例复发,余者均无肿瘤局部复发、远处转移。结论:在严格掌握适应证、丰富的开腹手术经验及熟练的腹腔镜手术技术基础上,腹腔镜手术治疗胃间质瘤是安全、可行的。     

双镜联合切除胃间质瘤的手术效果分析

目的:探讨双镜联合切除胃间质瘤的手术效果及临床应用价值。方法:回顾分析2009年1月至2013年8月收治的106例胃间质瘤患者的临床资料,均择期手术治疗,其中观察组50例行双镜(腹腔镜+内镜)联合切除术,対照组56例行腹腔镜切除木,比较两组手术效果(手术时间、手术出血量、术后胃肠功能恢复时间)及术后病理检査结果。结果:观察组手术时间、术中出血量、术后胃肠功能恢复时间均显著少于对照组差异有统计学意义(P0.05);两组下床活动时间、住院时间、术后病理结果差异均无统计学意义(P0.05)。结论:单纯腹腔镜、双镜联合切除术治疗胃间质瘤的住院时间、术后病理结果相似,但相较单纯腹腔镜手术,双镜联合切除术可有效缩短手术时间,减少术中出血量。     

腹腔镜微创外科治疗胃间质瘤17例报告

目的评价腹腔镜微创外科治疗胃间质瘤的临床价值。方法回顾性分析2005年3~10月经腹腔镜行包括肿瘤在内的胃部分切除术治疗的17例胃间质瘤的临床和病理资料。结果17例病人行腹腔镜下胃肿瘤切除术,平均手术时间(65±12)min,无并发症出现,平均住院时间5·3d。病理结果:极低风险4例,低度风险8例,中度风险4例,高度风险1例。随访1~6个月,无复发及转移。结论腹腔镜下胃局部切除治疗胃间质瘤是安全可行的。     

腹腔镜胃间质瘤的治疗进展

腹腔镜技术因具有患者创伤小,康复快的优势,已逐渐用于胃间质瘤的手术治疗.随着腹腔镜器械及操作技巧的不断改进,许多禁忌证已被突破,技术也日趋完善.现将腹腔镜治疗胃间质瘤的国内外进展作一综述.     

胃间质瘤的早期诊断及微创治疗

目的探讨胃镜、超声内镜、腹腔镜联合应用在小的胃间质瘤(直径5cm)诊断和治疗中的作用和价值。方法自2004年8月至2009年12月,对胃镜发现的胃黏膜下隆起性病变43例,进行超声内镜检查,初步诊断胃间质瘤29例(直径0.89~3.85cm,平均1.78cm)。随后在胃镜辅助定位下,行腹腔镜胃部分切除术。术后长期随访有无局部复发及远处转移。结果手术全部成功,手术时间35~90min,平均55min,无术后并发症及死亡病例。术后胃肠功能恢复时间18~36h,平均28h。住院时间3~5d,平均3.6d。术后病理诊断间质瘤者28例,神经鞘瘤1例,术前诊断符合率96.5%。28例胃间质瘤患者术后随访2~64个月,平均30个月,未发现肿瘤局部复发和转移。结论胃镜联合超声内镜有助于发现和诊断小的胃间质瘤,并可在术前初步判定其可切除性。在胃镜辅助定位下,行腹腔镜胃部分切除术治疗小的胃间质瘤安全、有效、预后良好。     

腹腔镜联合内镜治疗胃间质瘤临床分析

目的：探讨腹腔镜联合内镜治疗胃间质瘤的临床疗效,分析其可行性及临床应用价值。方法对20例胃间质瘤患者采用腹腔镜联合内镜进行微创手术。结果20例患者均顺利完成手术,无中转开腹,手术时间50～120 min（平均85 min）,术后无吻合口出血、梗阻、吻合口瘘等并发症,均顺利出院。结论腹腔镜技术能弥补内镜和影像学检查的不足,与内镜联合治疗胃间质瘤定位准确,创伤小,恢复快,安全可行,临床应用前景广阔。     

Minimally invasive surgery for posterior gastric stromal tumors

Background: Because involvement is extremely rare, surgery for gastric stromal tumors consists of local excision with clear resection margins. The aim of this study was to report the results of a consecutive series of nine patients with posterior gastric stromal tumors that were excised using a minimally invasive method. Methods: Patients received a general anesthetic before placement of three laparoscopic ports— a 10-mm (umbilical) port for the telescope and two working ports, a 12-mm port (left upper quadrant) and a 10-mm port (right upper quadrant). Grasping forceps were placed through an anteriorly placed gastrotomy to deliver the tumor through the gastrotomy into the abdominal cavity, thus allowing an endoscopic linear cutter to excise the tumor with a cuff of normal gastric tissue. Results: Nine consecutive patients with a median age of 73 years (range, 47–83) were treated. In seven patients, laparoscopic removal of the tumor was achieved. Two patients required conversion to an open operation because the tumor could not be delivered into the abdominal cavity. The median length of postoperative stay for the seven patients in whom the procedure was completed laparoscopically was 3 days (range, 2–6). Conclusions: Posterior gastric stromal tumors can be removed safely using this minimally invasive method. Delivery of the tumor through the gastrotomy is essential for success. Received: 30 April 1999/Accepted: 12 July 1999     

微创肌肉非损伤性开胸术治疗贲门肿瘤

目的探讨微创肌肉非损伤性开胸行贲门肿瘤手术的可行性. 方法采用经左胸第7肋间微创肌肉非损伤性开胸行贲门肿瘤手术25例. 结果 20例贲门腺癌,4例鳞癌,行近端胃大部和食管下段切除,残胃-食管胸内吻合术.1例贲门部增生型息肉,行胃底切开,肿瘤摘除术.全组患者无围术期严重并发症,无手术死亡. 结论微创肌肉非损伤性开胸术操作简单,暴露充分,对相对早期的贲门癌是一种可选择的手术方法.     

胃恶性间质瘤的临床诊治

笔者回顾性分析8例胃恶性间质瘤患者的临床资料。诊断采用免疫组织化学法。病变部位4例在胃体，3例在胃窦，1例发生在胃贲门；其中5例高度恶性，3例低度恶性。1例因广泛转移仅行活检，1例姑息切除术，6例行根治术。仅行活检1例术后4个 月死亡；姑息性切除1例术后复发；行根治术6例均生存，最长者达5年。提示免疫组化检查可确定胃恶性间质瘤的恶性程度；手术应争取行根治性手术，对预后及防止复发有一定意义。     

胃肠间质瘤的外科治疗及预后分析

目的探讨胃肠间质瘤（GIST）~科治疗效果及其影响因素。方法对中山大学肿瘤防治中心1990年1月至2010年2月间收治的首次进行外科治疗且能够完全切除的277例GIST患者临床资料进行回顾性分析,对其病理切片重新复核并加以随访。结果277例患者中男性176例,女性101例,年龄20～81（中位年龄57）岁;肿瘤位于结直肠28例,小肠76例,胃173例。均予以肿瘤完整切除,其中局部切除98例,肿瘤及所在器官切除64例。扩大切除术115例：3种切除方式患者术后5年生存率分别为83．5％、71．9％和61．9％,差异无统计学意义（P〉0．05）。Cox模型分析显示,肿瘤大小和复发转移是影响GIST患者预后的独立因素（P〈0．05）。结论胃肠道GIST仍以外科治疗为主．原则上施行肿瘤完全切除即可．广泛切除或扩大淋巴结清扫并不能提高生存率。     

Minimally invasive gastric surgery

The most common indications for gastric resection remain benign ulcer disease and neoplasm. Surgery for these diseases can be performed safely with laparoscopy. As surgeons adhere to the original tenets of open gastric resections while performing laparoscopic resections, disease outcomes will remain the same with the improved surgical outcomes of less pain, a shorter hospital stay, and a lower incidence of wound complications. Laparoscopic gastric resections can be divided into the more straightforward wedge/tumor resections performed for submucosal tumors or the more formal anatomic gastric resections. This article reviews the tools and techniques for laparoscopic gastric resection.     

Minimally invasive surgery for gastric stromal cell tumors: intermediate follow-up results

Laparoscopic wedge resection of the stomach (LWS) has become the treatment of choice for patients with benign gastric tumors. The technical consideration and long-term follow-up data of LWS for gastrointestinal stromal tumors (GISTs) of the stomach are limited. We present our experience of 28 LWSs for gastric GISTs with a mean follow-up of 43 months. From October 1995 to December 2002, we successfully performed 28 LWSs for 29 patients with GISTs of the stomach, and one patient needed conversion to laparotomy because of suspected bowel injury when establishing pneumoperitoneum. Patient demographics, perioperative parameters, and outcomes of the 28 patients were assessed retrospectively. The tumors were located in the upper third of the stomach in 13 patients, in the middle third, in eight patients, and in the lower third, in seven patients. The mean size of tumors was 3.4 ± 1.6 cm in diameter. The duration of operation ranged from 95 to 390 minutes: 189.6 ± 79.5 minutes with the stapler method and 194.3 ± 50.5 minutes with the hand-sewn method (P = 0.8870). No blood transfusion was given in the perioperative period in all cases. Cholecystectomy in three patients and repair of hiatal hernia in one patient were performed during the same operation. The oral intake was restored at the third to fourth postoperative days. The hospital stay ranged from 3 to 11 days (mean, 6.7 ± 1.8 days). The follow-up period ranged from 12 to 95 months (mean, 43.3 ± 23.5 months, median 42 months). There has been no evidence of tumor recurrence, including one patient with microscopic invasion of section margin. LWS can be performed safely with a satisfactory remission rate for patients with gastric stromal cell tumors. Presented at the 94th Annual Meeting of the Surgical Association of Taiwan, March 27, 2005, Tao-Uan, Taiwan.     

Minimally invasive surgery in the treatment of gastric cancer

Unlike benign pathology, progress of laparoscopy in performing cancer surgery has been slow because of fear of safety and oncological adequacy. However, the initial fear has been replaced by optimism as the results from a numerous studies have shown equivalent if not superior results to open surgery. Laparoscopic gastrectomy is safe and oncologic adequate, but time consuming and technically demanding procedure. Laparoscopic surgery has gained wide acceptance in the treatment of early gastric cancer, especially of the distal stomach. The use of laparoscopic surgery for the treatment of advanced gastric cancer remains controversial. Another open question that need complete evaluation is cost-effectiveness analysis of minimally invasive and open approach.     

胃间质瘤的诊断与外科治疗

胃间质瘤（GST）是胃肠道间质瘤（GIST）中最常见的肿瘤,近年来临床诊断率有逐年增多趋势。因为该肿瘤独特的生物学行为和临床特性,临床应给予充分的了解和重视。本文就GST的生物学特性、临床诊断要点、外科治疗原则、外科联合靶向药物治疗原则、预后判断、以及临床注意事项等进行简要论述,以期对临床治疗提供参考。     

微创治疗颧弓颧骨骨折80例临床观察与分析

目的:对颧骨颧弓骨折实施微创治疗的临床效果进行观察分析。方法:选取2007年1月～2013年1月唐山市玉田县医院口腔科收治的80例实施微创治疗的颧骨颧弓骨折患者,作为微创组。同时选取同一时期采用常规方法进行治疗的80例颧骨颧弓骨折患者,作为常规组。对两组患者的治疗效果进行观察比较。结果:微创组80例患者手术治疗后没有出现不良反应,而常规组80例患者出现不良反应的几率是3.75%。同时微创组80例患者治疗的优良率是100.00%;常规组80例患者治疗的优良率是97.50%。由结果可以看出,微创组患者的治疗效果明显好于常规组(P<0.05)。结论:对患者实施微创治疗,不仅简化了治疗过程,缩短了治疗时间,同时还降低了对患者的损伤,提高了患者的生活质量,值得临床推广使用。     

胃癌合并胃间质瘤的诊治体会

目的 探讨胃癌合并胃间质瘤的诊断与治疗.方法 回顾性分析1996年1月至2009年12月18例胃癌合并胃间质瘤患者的临床资料.结果 本组18例患者均无特异性临床表现,术前确诊1例,术中确诊3例,术后确诊14例.胃癌病灶大小平均为(3.3±2.3)cm,胃间质瘤病灶大小平均为(0.9±0.5)cm.胃间质瘤病灶处于低度危险性16例,中度危险性2例.所有病例手术顺利,术后1、3、5年总体生存率分别为88%、63%和36%.结论 胃癌合并胃间质瘤的临床表现无特异性,其中胃间质瘤多为早期病灶,恶性程度低,采取以手术为主的综合治疗,预后主要取决于胃癌病灶.

Abstract：

Objective To study the diagnosis and treatment of synchronous gastric cancer and gastric stromal tumor in 18 cases. Methods Clinical data of 18 cases of synchronous occurrence of gastric cancer and gastric stromal tumor from January 1996 to December 2009 were analyzed retrospectively.Results Clinical features of all cases were atypical. There was 1 case diagnosed preoperatively, 3 cases diagnosed intraoperatively and 14 cases diagnosed postoperatively. The mean size of gastric cancer and gastric stromal tumor was (3.3±2.3) cm and (0.9 ±0.5) cm respectively. There were 16 cases of gastric stromal tumor in low risk of malignance and 2 cases in moderate risk of malignance. All cases were operated without complications and the 1-year, 3-year and 5-year overall survival rate was 88.2%, 63.2% and 36. 1% respectively. Conclusions Clinical features of synchronous occurrence of gastric cancer and gastric stromal tumor are atypical, in this series most gastric stromal tumors are in early stage and of low risk of malignance. The prognosis of patients with synchronous occurrence of gastric cancer and gastric stromal tumor mainly depends on gastric cancer.