CAJ | 학술논문

目的：探讨胃肠道小间质瘤临床特点和诊治方法。方法回顾性分析解放军总医院2004年10月-2010年4月接受手术治疗的55例胃肠道小间质瘤患者的临床资料,同时进行随访分析。结果55例中有临床症状者占58.2%；胃部间质瘤占80.0%,其中胃上部间质瘤占52.7%。 Fletcher危险度分级极低和低度占92.7%,肿瘤直径≤1 cm危险度分级更低,Ki-67阳性与危险度分级无关。肿瘤切除采取微创手术者33例(微创手术组),其中腹腔镜下切除17例,内镜下切除14例,双镜联合局部切除2例；采取传统开放手术者22例(开放手术组),其中局部切除18例,近端胃切除3例,胰十二指肠切除1例。微创手术组较开放手术组术中出血量及术后开始进食时间差异均有统计学意义(P<0.01,P<0.05)。38例获得随访,随访时间26~104个月,中位时间41个月,仅1例胃体间质瘤内镜下切除术后22个月复发。结论胃肠道小间质瘤患者仅半数有临床症状,肿瘤多生长于胃上部,危险度分级及复发风险低,Ki-67不能作为判断胃肠道小间质瘤预后的指标。微创手术治疗安全、有效。
목적：탐토위장도소간질류림상특점화진치방법。방법회고성분석해방군총의원2004년10월-2010년4월접수수술치료적55례위장도소간질류환자적림상자료,동시진행수방분석。결과55례중유림상증상자점58.2%；위부간질류점80.0%,기중위상부간질류점52.7%。 Fletcher위험도분급겁저화저도점92.7%,종류직경≤1 cm위험도분급경저,Ki-67양성여위험도분급무관。종류절제채취미창수술자33례(미창수술조),기중복강경하절제17례,내경하절제14례,쌍경연합국부절제2례；채취전통개방수술자22례(개방수술조),기중국부절제18례,근단위절제3례,이십이지장절제1례。미창수술조교개방수술조술중출혈량급술후개시진식시간차이균유통계학의의(P<0.01,P<0.05)。38례획득수방,수방시간26~104개월,중위시간41개월,부1례위체간질류내경하절제술후22개월복발。결론위장도소간질류환자부반수유림상증상,종류다생장우위상부,위험도분급급복발풍험저,Ki-67불능작위판단위장도소간질류예후적지표。미창수술치료안전、유효。
Objective To investigate the clinical features, diagnosis and treatment methods of small gastrointes-tinal stromal tumors ( GISTs) . Methods Clinical data of 55 patients with small GISTs undergoing surgery during Octo-ber 2004 and April 2010 was retrospectively analyzed, and follow-up analysis was performed at the same time. Results Among the 55 small GISTs patients, the percentage of patients with clinical symptoms was 58. 2% and patients with gas-tric tumors were 80. 0% respectively including 52. 7% in upper stomach. The percentage of patients with very low and low grade of Flecture risk classification was 92. 7%, and risk classification of tumor diameter of no more than 1cm was lower, but positive Ki-67 had nothing to do with the risk classification. Minimally invasive tumor resection was performed in 33 cases ( minimally invasive group) including 17 cases of laparoscopic gastric partial resection, 14 cases of endoscop-ic submucosal dissection and 2 cases of laparoscopic combined with endoscopic surgery; open tumor resection was per-formed in 22 cases ( open tumor resection group) including 18 cases of gastric partial resection, 3 cases of proximal gas-trectomy and 1 case of pancreaticoduodenectomy. The differences in bleeding volum and postoperative dieting time be-tween the open surgery group and minimally invasive surgery group were statistically significant (P<0. 01, P<0. 05). A total of 38 patients were followed up for 26-104 months, median time was 41 months, and only one patient had relapse 22 months after endoscopic submucosal dissection. Conclusion Only half of small GIST patients have clinical manifesta-tions, most of the tumors are located in the upper part of the stomach with low risk and recurrent risk, but Ki-67 can not be used as prognostic indicator of small GIST. Minimally invasive surgery is safe and effective.