CAJ | 학술논문

目的总结胃间质瘤(GIST)的临床病理及免疫组织化学特征,探讨胃GIST诊断与治疗的方法及影响其预后的因素.方法回顾性总结2001年7月~2010年5月苏州大学附属第一医院普通外科收治的19例经手术治疗的胃GIST患者的临床资料,并进行Flecther侵袭危险性分级和预后分析.结果肿瘤中位直径7.0cm(1.5~14.5cm).行胃部分切除8例,近端胃大部切除4例,远端胃大部切除1例,全胃切除6例,其中联合胆囊切除2例,联合胰体尾及脾切除1例,联合左肝外侧叶切除1例,行D2淋巴结清扫6例(均无淋巴结转移),术后服用甲磺酸伊马替尼9例.CD117(+)73.7%,CD34(+)82.4%, SMA(+)26.7%,S-100(+)52.9%.术后有6例出现复发转移,2例出现肝转移,1例后腹膜转移.l例腹腔广泛转移,2例死亡,4例带瘤生存.单因素分析发现:肿瘤直径≥5cm、核分裂象≥5/50 HPF以及高危病人为胃GIST复发转移的预测因素.结论胃GIST高危病人术后出现复发或转移的可能性大,高危和复发转移者应配合甲磺酸伊马替尼辅助治疗.
목적총결위간질류(GIST)적림상병리급면역조직화학특정,탐토위GIST진단여치료적방법급영향기예후적인소.방법회고성총결2001년7월~2010년5월소주대학부속제일의원보통외과수치적19례경수술치료적위GIST환자적림상자료,병진행Flecther침습위험성분급화예후분석.결과종류중위직경7.0cm(1.5~14.5cm).행위부분절제8례,근단위대부절제4례,원단위대부절제1례,전위절제6례,기중연합담낭절제2례,연합이체미급비절제1례,연합좌간외측협절제1례,행D2림파결청소6례(균무림파결전이),술후복용갑광산이마체니9례.CD117(+)73.7%,CD34(+)82.4%, SMA(+)26.7%,S-100(+)52.9%.술후유6례출현복발전이,2례출현간전이,1례후복막전이.l례복강엄범전이,2례사망,4례대류생존.단인소분석발현:종류직경≥5cm、핵분렬상≥5/50 HPF이급고위병인위위GIST복발전이적예측인소.결론위GIST고위병인술후출현복발혹전이적가능성대,고위화복발전이자응배합갑광산이마체니보조치료.
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 19 cases with gastric GISTs from January 2001 to May 2010 were analyzed retrospectively.All patients were treated by surgery.All the 19 cases were grouped according to the Fletcher 4-tier system for predicting the aggressiveness of GISTs.Results Tumor diameter ranges from 1.5 to 14.5cm,with median diameter 7.0cm.8 cases received partial gastrectomy,4 proximal gastrectomy,1 distal gastrectomy,and 6 total gastrectomy.2 patients underwent curative combined resection,1 with pancreticosplenectomy,1 with left lateral lobectomy of liver.6 underwent parallel D2 dissection.9 cases were subjected to imatinib mesylate therapy after surgery.The positive rate of CD117 was 73.7%,Vimentin 77.8%,CD34 82.4%,SMA 26.7%,and S-100 52.9%.Postoperative recurrence or metastasis occurred in 6 cases.2 cases developed liver metastasis,1 retroperitoneal metastasis,and 1 extensive intra-peritoneal metastasis.2 patients died,and 4 survived with tumors.Univariate analysis showed that tumor diameter≥5cm,mitoses≥5/50 HPF,and high-risk gastric GISTs were the factors associated with adverse outcome. Conclusions High risk gastric GISTs have higher possibilities of postoperative recurrence or metastasis.Patients with high-risk gastric GISTs or recurrence developed should be treated with imatinib mesylate.