胃肠恶性间质细胞瘤的手术和靶向治疗的探讨

目的探讨胃肠恶性间质细胞瘤的手术切除和分子靶向治疗的临床效果。方法回顾性分析我院2000-2007年收治的16例胃肠恶性间质细胞瘤的手术和靶向治疗的病例资料。结果手术及围手术期无死亡病例，无术后严重并发症发生。根治性手术11例中3年生存9例（9／11），5年生存5例（5／11）。术后有6例口服伊马替尼（Imatinib）接受靶向治疗，（根治性手术2例，非根治性手术4例，其中1例为再次手术）。再手术者为腹腔GIST，首次术后11月时出现肠梗阻症状，再手术见为局部复发并形成肠粘连，行侧侧吻合术，术后口服伊马替尼至今生存良好。非根治性手术中2例未行靶向治疗而接受化疗，于术后18个月、23个月死亡。所有接受靶向治疗者生存质量良好。结论①胃肠问质细胞瘤（gastrointestinal stromal tumor GIST）是指源发于胃肠非上皮性肿瘤，属于消化道间叶源性肿瘤；②治疗进展首先，手术治疗，首次手术一定要以达到根治为目标。在手术过程中往往有较多的联合脏器切除。其次，分子靶向治疗，甲磺酸伊马替尼（Imatinib mesylate）治疗GIST是肿瘤靶向治疗的成功典范，是分子水平治疗肿瘤的体现；③根治手术＋靶向治疗对GIST的治疗而言，是目前肿瘤治疗中的最佳组合。是否可大幅度提高临床效果，有待继续观察。甲磺酸伊马替尼（Imatinib mesylate）耐药有替代产品。

Discussion operation and treated therapy on gastrointestinal stromal tumour patients

Objective To explor quality surgery,cell of tumour excise with molecule target to the clinical result that is treated probe into intestines and stomach malignant. Methods Our hospital were retrospectively analyzed 16 patients admitted 2000-2007 gastrointestinal stromal cell tumor surgery and targeted therapy in cases of information. Results Surgery and no perioperative deaths and no serious postoperative complications occurred. 11 cases of radical surgery in 3-year survival in 9 cases (9/11), 5-year survival of 5 cases (5/11). 6 cases of postoperative oral administration of imatinib mesylate (Imatinib) receiving targeted therapy, (radical surgery in 2 cases,4 cases of non-radical surgery, of which 1 case was re-surgery). Re-operation were intra-abdominal GIST, for the first time in November when postoperative bowel obstruction symptoms, the re-operation for local recurrence and the formation of adhesions,line side to side anastomosis, after oral administration of imatinib had a good life. Non-radical surgey in 2 cases without targeted therapy and chemotherapy, died in 18 months,23 months ofter operation. All of the survival of good quality targeted therapy. Conclusion ①gastrointestinal stromal tumor(gastrointestinal stromal tumor GIST)is the source of fat in the gastrointestinal non-epithelial tumors,mesenchymal tumors belong to the digestive tract. ②The treatment of first surgery, the first time, radical surgery must be to achieve the goal. During surgery tend to have more visceral resection. Second, the molecular targeted therapy imatinib mesylate(Imatinib mesylate) treatment of GIST is a successful example of targeted therapy is the treatment of tumors reflects the molecular level. (3) radical surgery + targeted therapy for GIST treatment, the cancer treatment is the best combination and Whether it can greatly improve the clinical results, need to continue to observe. Imatinib mesylate(Imatinib mesylate)-resistant with alternative products.