46例胃肠道间质瘤的临床诊治分析

目的探讨胃肠道间质细胞瘤的诊断和治疗。方法回顾性分析1997年1月至2005年1月收治的46例胃肠道间质细胞瘤的临床资料。结果本组46例均行手术治疗。无手术中死亡病例。术后在切口感染及其它严重并发症。术后获得随访42例。其中良性及交界性GIST获得随访26例（26／28），平均随访30个月，为无瘤生存。恶性GIST获得随访15例，平均随访21个月。其中7例为无瘤生存，2例分别于术后第10及21个月发生肝多发性转移。1例术后20个月发生全身骨转移，3例分别于术后第6、9及11个月死于多发性远处转移。结论GIST由于缺乏特异的临床表现，影像学及内镜检查往往在术前亦难以作出定性诊断，但B超内镜引导下细针穿刺活检及免疫组化检查对诊断比较可靠。手术治疗效果良好。手术治疗的原则是：良性及交界性GIST以局部切除为主，恶生GIST宜行较大范围的手术，必要时须行联合脏器切除术。

Diagnosis and treatment of gastrointestinal stromal tumors (Analysis of 46 cases)

Objective To study the diagnosis and treatment for gastrointestinal stromal tumors(GIST). Methods From January 1997 to April 2005, 46 cases with gastrointestinal stromal tumors were analyzed retrospectively. Results The operative treatment was performed in all cases. No intraoperative death, no postoperative wound infection and other severe complications were found. Postoperative follow-up was gotten in 42 cases. Among them, benign and junctional GIST were followed-up in 26 cases (26/28). Average follow-up was 21 months and no tumor survivorship was in all cases. Malignant GIST was follow-up in 15 cases and average follow-up was 21 months. Among them, no tumor survivorship was in 7 cases. Multiple hepatic metastases were occured in 2 cases 10th and 21th month after operation respectively. General bone metastases were happened in 1 case 20th month after operation. 2 cases were relapse in the omentum and neighbor peritoneum and reoperation was performed. 3 cases died from remote metastases 6, 9 and 11th month after operation respectively. Conclusion Because of GIST lacks of specific clinical manifestation, the qualitative diagnosis is difficultly made by the imaging and endoscopy before operation. But using fine needle biopsy of ultrasonic endoscope guided, the diagnosis of GIST is more reliable. Effect of operative treatment is better. The principles of operative treatment are as follows: Binign and junctional GIST are local resection. The more extensive resection is suitable for malignant GIST and combined devisceration should be performed if need be.