低位直肠间质瘤腹腔镜辅助下的经内外括约肌间切除术*

目的：针对伊马替尼治疗下的低位直肠间质瘤，探讨腹腔镜辅助下经内外括约肌间切除术的安全性和可行性。方法：随访2007年1 月至2011年1 月9 例低位直肠间质瘤患者，在术前接受伊马替尼治疗后行腹腔镜辅助下的经内外括约肌间切除术。结果：伊马替尼治疗前肿瘤大小为5～9 cm（中位值7.0 cm），治疗后肿瘤大小为2～4.5 cm（中位值3.5 cm）（P < 0.001）。 治疗3～24个月（中位值7 个月）行腹腔镜辅助下的经内外括约肌间切除术，住院时间5~ 9 天（中位值7 天），所有患者均行保护性造口，术后3 个月行造口还纳术。Wexner评分在伊马替尼治疗前为1～4 分（中位值2 分），治疗后为1～5 分（中位值2 分）（P = 0.397）；造口还纳术后Wexner评分4～9 分（中位值7 分），较术前明显增加（P < 0.001），术后1 年为1～5 分（中位值2 分），与术前比较差异无统计学意义（P = 0.842）。 术后有6 例继续服用伊马替尼24～30个月。1 例未继续服用伊马替尼，患者在30个月时出现盆底复发。结论：腹腔镜辅助下的经内外括约肌间切除术对于低位直肠间质瘤的治疗是安全可行的。

Laparoscopy- guided intersphincteric resection for low rectal stromal tumor

Objective:To investigate the clinical security and feasibility of neoadjuvant chemotherapy with imatinib following lap-aroscopy-guided intersphincteric resection for patients with gastrointestinal stromal tumor of the low rectum (GSTLR). Methods:Clini-cal data of nine patients with GSTLR who were admitted to the Shengjing Hospital between January 2007and January 2011 were re-viewed. These patients were treated with neoadjuvant imatinib chemotherapy after laparoscopic intersphincteric resection. Results: Pri-or to neoadjuvant chemotherapy, the tumor diameter ranged between from 5 cm to 9 cm (median=7.0 cm). After imatinib chemothera -py, the tumor diameter decreased to 2- 4.5 cm (median=3.5 cm, P<0.001). Laparoscopic surgery through intersphincteric resection was performed after imatinib treatment for 3- 24months (median=7 months). All patients received a protective stoma, which was closed 3months after the surgery. The Wexner scale scores ranged from1 and 4 (median= 2) prior to neoadjuvant imatinib chemotherapy and changed to 1- 5 (median= 2) after the chemotherapy ( P=0.397). After stomal closure operation, the scores significantly increased to 4- 9 (median= 7, P<0.001) but were not statistically significantly different from those before the therapy. One year after laparoscopic surgery, the Wexner scale scores ranged from 1 to 5 (median= 2, P=0.842). Six patients were treated with imatinib for 24and 30months after lap-aroscopic surgery. Recurrence in pelvis occurred in only one patient, who ceased imatinib administration at the 30th month after the surgery. Conclusions: Laparoscopic surgery through intersphincteric resection was secure and feasible and thus could be used for treat-ment of GSTLR.