中华胃肠外科杂志
中華胃腸外科雜誌
중화위장외과잡지
CHINESE JOURNAL OF GASTROINTESTINAL SURGERY
2009年
1期
24-27
,共4页
戎龙%万远廉%年卫东%柳萍%梁进雨
戎龍%萬遠廉%年衛東%柳萍%樑進雨
융룡%만원렴%년위동%류평%량진우
胃肿瘤%胃肠间质瘤%预后%外科手术
胃腫瘤%胃腸間質瘤%預後%外科手術
위종류%위장간질류%예후%외과수술
Stomach neoplasms%Gastrointestinal stromal tumors%Prognosis%Surgical procedures
目的 总结胃间质瘤(胃GIST)的临床病理及免疫组织化学(免疫组化)特征,探讨胃GISTs诊断与治疗的方法及影响其预后的因素.方法 总结1997年1月至2007年5月北京大学第一医院普通外科收治的63 例经手术治疗的胃GISTs患者的临床资料,并进行Flecther侵袭危险性分级和预后分析.结果 B超、CT及内镜超声(EUS)对本组患者的术前诊断准确率分别为72.2%、81.0%和94.3%,χ3=6.065,P<0.05;差异有统计学意义.CD117阳性率88.9%,CD34阳性率95.1%.开腹或腹腔镜行胃部分切除38 例,近端胃大部切除4 例,远端胃大部切除8 例;全胃切除13 例.其中联合胆囊切除3 例,联合胰体尾及脾切除7 例;联合左肝外侧叶切除1例,行D:淋巴结清扫12 例(均无淋巴结转移).全组病例1、3、5年生存率分别为96.4%、84.7%和71.7%.单因素分析显示,侵袭危险性分级和肿瘤大小是影响患者生存的因素(P<0.05);而性别、年龄、核分裂像、免疫组化表达情况、是否联合脏器切除以及是否行淋巴结清扫与预后无关(P0.05).多因素分析显示,侵袭危险性分级是胃GIST的独立预后因素(P=0.041).结论 术前EUS诊断准确率最高.建议用Fletcher侵袭危险性分级方法来判断胃GISTs的生物学行为及其预后.
目的 總結胃間質瘤(胃GIST)的臨床病理及免疫組織化學(免疫組化)特徵,探討胃GISTs診斷與治療的方法及影響其預後的因素.方法 總結1997年1月至2007年5月北京大學第一醫院普通外科收治的63 例經手術治療的胃GISTs患者的臨床資料,併進行Flecther侵襲危險性分級和預後分析.結果 B超、CT及內鏡超聲(EUS)對本組患者的術前診斷準確率分彆為72.2%、81.0%和94.3%,χ3=6.065,P<0.05;差異有統計學意義.CD117暘性率88.9%,CD34暘性率95.1%.開腹或腹腔鏡行胃部分切除38 例,近耑胃大部切除4 例,遠耑胃大部切除8 例;全胃切除13 例.其中聯閤膽囊切除3 例,聯閤胰體尾及脾切除7 例;聯閤左肝外側葉切除1例,行D:淋巴結清掃12 例(均無淋巴結轉移).全組病例1、3、5年生存率分彆為96.4%、84.7%和71.7%.單因素分析顯示,侵襲危險性分級和腫瘤大小是影響患者生存的因素(P<0.05);而性彆、年齡、覈分裂像、免疫組化錶達情況、是否聯閤髒器切除以及是否行淋巴結清掃與預後無關(P0.05).多因素分析顯示,侵襲危險性分級是胃GIST的獨立預後因素(P=0.041).結論 術前EUS診斷準確率最高.建議用Fletcher侵襲危險性分級方法來判斷胃GISTs的生物學行為及其預後.
목적 총결위간질류(위GIST)적림상병리급면역조직화학(면역조화)특정,탐토위GISTs진단여치료적방법급영향기예후적인소.방법 총결1997년1월지2007년5월북경대학제일의원보통외과수치적63 례경수술치료적위GISTs환자적림상자료,병진행Flecther침습위험성분급화예후분석.결과 B초、CT급내경초성(EUS)대본조환자적술전진단준학솔분별위72.2%、81.0%화94.3%,χ3=6.065,P<0.05;차이유통계학의의.CD117양성솔88.9%,CD34양성솔95.1%.개복혹복강경행위부분절제38 례,근단위대부절제4 례,원단위대부절제8 례;전위절제13 례.기중연합담낭절제3 례,연합이체미급비절제7 례;연합좌간외측협절제1례,행D:림파결청소12 례(균무림파결전이).전조병례1、3、5년생존솔분별위96.4%、84.7%화71.7%.단인소분석현시,침습위험성분급화종류대소시영향환자생존적인소(P<0.05);이성별、년령、핵분렬상、면역조화표체정황、시부연합장기절제이급시부행림파결청소여예후무관(P0.05).다인소분석현시,침습위험성분급시위GIST적독립예후인소(P=0.041).결론 술전EUS진단준학솔최고.건의용Fletcher침습위험성분급방법래판단위GISTs적생물학행위급기예후.
Objective To analyze the clinicopathological characteristics of gastric gastrointestinal stromal tumors (gastric GISTs) and to explore the diagnosis, treatment and prognosis of gastric GISTs. Methods Clinical data of 63 cases with gastric GISTs from January 1997 to May 2007 were analyzed retrospectively. All patients were treated by surgery. All the 63 cases were grouped according to the Fletcher 4-tier system for predicting the aggressiveness of GISTs. Survival was calculated by Kaplan-Meier method. Univariate and multivariate analyses were performed using log-rank analysis and Cox regression model respectively to evaluate the prognostic factors. Results The accuracy of preoperative ultrasonography, CT and EUS was 72.2%, 81.0% and 94.3% respectively. The diagnostic accuracy of EUS was significantly higher than those of ultrasonagraphy and CT (X2=6.065, P<0.05). Of the 63 gastric GISTs, 31 cases (49.20%) were at fundus. Immunohistochemistry staining revealed that the positive rates of CD117 and CD34 were 88.9% and 95.1% respectively. The 1-, 3- and 5-year total survival rates of 63 patients were 96.4%, 84.7% and 71.7% respectively. Univariate analysis revealed that the differences of Fletcher classification and tumor size were significant. No significant differences in gender, age, mitotic index, immunohistochemistry expression and multi-organ resection existed among the groups. Multivariate analysis demonstrated that Fletcher classification was the independent poor prognostic factor for survival. Conclusions The preoperative diagnostic accuracy of EUS is significantly higher than those of ultrasonography and CT. Fletcher classification is reasonable and feasible to evaluate the prognosis of gastric GISTs.
