胃肠道间质瘤的临床特点与外科治疗

胃肠道间质瘤(GIST)起源于胃肠道Cajal间质细胞,ckit基因表达阳性。据估计GIST发病率为15～20100万人,好发部位依次是胃(84%)、小肠(10%)、直肠(4%)、食管(1%)及大网膜(1%)。GIST是一种侵袭性肿瘤,可分为低度和高度恶性。一般认为肿瘤直径>5cm、核分裂>550个高倍视野、肿瘤包膜浸润及邻近器官或远隔转移,就应考虑高度恶性。内镜和X线钡餐检查是本病术前诊断的主要手段。因为化疗及放疗对胃肠道间质瘤无效,故一旦明确诊断首选外科治疗。手术不主张常规实施标准淋巴结清扫,但要求完全切除肿瘤对腹膜复发和肝转移病例也可选用伊马替尼治疗。GIST的生物学行为多表现为良性经过,预后良好。与食管和胃GIST相比,空肠及回肠GIST的预后不佳。

The Clinical Characteristics and Surgical Treatment of Gastrointestinal Stromal Tumor

Gastrointestinal stromal tumours(GIST) originate in gastrointestinal stromal cells,the c-kit gene of which indicates positive.It is estimated that the incidence of GIST is 15～20/ million people,the frequently-occuring parts rated from stomach(84%),small intestine(10%),rectum(4%),esophagus(1%) to greater omentum(1%).GIST is a kind of aggresive tumour-can be divided into two categories of less malignant and highly malignant.It is generally considered that if tumour diameter>5cm,cell division>5/50 HP,tumour membrane being infiltrated and the matastasis of the adjent organs,highly malignant should be taken into consideration.Endoscopy and X-ray barium meal are the principal methods for the pre-operation diagnoses of this disease.Due to the failure of chemotherapy and radiotherapy to GIST,surgical treatment is the priority once a definite diagnose is made.We recommend total excision rather than routine applied standard lymph node clean-up.Imatinib treatment is optional for peritoneum relapse and the metastasis of liver cancer.The biology behavior mostly shows a benign course and a perfect recovery.Compared with esophagus and stomach GIST,the prognosis of jejunum and ileum GIST is poor.