217例胃间质瘤的临床特点与诊治

目的 探讨胃间质瘤的临床特点、诊断与治疗方法.方法 对笔者所在医院2007年10月至2011年7月期间收治的217例胃间质瘤患者的临床资料进行回顾性分析.结果 胃间质瘤患者的临床表现主要有腹痛、上腹胀、血便、腹部包块等.术中见肿瘤位于贲门部、胃底、胃体及幽门部分别为24例(11.0％)、103例(47.5％)、59例(27.2％)和31例(14.3％).所有患者的肿瘤均于内镜下剥除或行手术切除,术后经病理及免疫组化检查确诊.属极低危险度、低危险度、中危险度及高危险度患者分别为56例(25.8％)、67例(30.9％)、41例(18.9％)和53例(24.4％).术后140例患者获得随访,随访时间为7～52个月,平均35个月.获得随访的35例高危险度患者中,服用伊马替尼者19例,2例进展；未服用者16例,9例进展,服用伊马替尼者病情进展的比例较低(x2=8.426,P=0.004).在11例病情进展患者中,局部复发4例、复发合并腹腔多处转移1例、肱骨转移1例、肝转移合并腹腔转移1例、肝转移4例.结论 胃间质瘤缺乏特异性临床表现,手术完整切除肿瘤是主要的治疗手段,伊马替尼可改善高危险度患者的预后.

Clinical Characteristics,Diagnosis and Treatment of 217 Patients with Gastric Stromal Tumor

Objective To investigate the clinical characteristics,diagnosis,and treatment of gastric stromal tumor.Methods Clinical data of 217 patients with gastric stromal tumor from October 2007 to July 2011 were analyzed.Results The main clinical manifestation were abdominal pain,abdominal distension,bloody stools,abdominal mass,and so on.The tumour located at cardiac part,fundus of stomach,body of stomach,and pylorus part was 24 cases(11.0%),103 cases(47.5%),59 cases(27.2%),and 31 cases(14.3%),respectively.All the 217 patients underwent endoscopic or surgical resection and diagnosed by pathology and immunohistochemistry.The patients of high-low risk,low risk,intermediate risk,and high risk was 56 cases(25.8%),67 cases(30.9%),41 cases(18.9%),and 53 cases(24.4%),respectively.One hundred and forty patients were followed-up for 7-52 months(average 35 months).Thirty-five patients of high risk were investigated about the drug treatment after the first operation: 19 cases were treated by using imatinib(tumor progressed in 2 cases)and 16 patients were not(tumor progressed in 9 patients).The rate of progression of patients treated by imatinib was significantly lower than another group(χ2=8.426,P=0.004).In 11 patients with tumor progressed,tumor recurrnce in 4 cases,tumor recurrence with diffused abdominal cavity metastasis in 1 case,tumor metastasized to humerus in 1 case,metastasized to liver and abdominal cavity in 1 case,and metastasized to liver in 4 cases.Conclusions Gastric stormal tumor is lack of specific clinical manifestations.Complete excision of the tumor is the main therapy method,and imatinib can improve prognosis.