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目的探讨胃肠道间质瘤(GIST)的临床表现及诊治方法。方法回顾性分析2003~2008年期间我院收治的35例GIST患者的临床表现和随访资料。结果 GIST发生部位:胃22例(62.8%),小肠8例(22.9%),结直肠2例(5.7%),腹膜后或肠系膜3例(8.6%)。免疫组织化学检测显示,CD117(+)32例(91.4%),CD34(+)18例(51.4%),SMA(+)4例(11.4%),S100(+)2例(5.7%)。35例患者均接受了手术治疗,其中根治性手术30例,非根治性手术5例,联合脏器切除10例。随访中位时间34个月,随访率为100%(35/35)。全组患者1、3、5年累积生存率分别为95.4%、87.2%和77.9%。本组患者中有3例术后复发转移患者服用甲磺酸伊马替尼的患者至今仍带瘤生存。患者的5年累积生存率与肿瘤大小、有无肿瘤坏死、核分裂数、肿瘤细胞核异型性、肿瘤部位及手术方式有关(P<0.05)。结论 GIST主要通过术后病理和免疫组织化学检测明确诊断,完整的局部手术切除是最有效的治疗手段,复发转移病例需要手术与药物治疗的结合。
Objective To investigate the clinical manifestations and diagnosis and treatment of gastrointestinal stromal tumors (GIST). Methods The clinical manifestations and follow-up data of 35 GIST patients admitted to our hospital from 2003 to 2008 were retrospectively analyzed. Results The incidence of GIST was 22 (62.8%) in the stomach, 8 (22.9%) in the small intestine, 2 (5.7%) in the rectum, and 3 (8.6%) in the retroperitoneal or mesentery. Immunohistochemistry showed that CD117 (+) 32 cases (91.4%), CD34 (+) 18 cases (51.4%), SMA (4 cases) 11.4% and S100 (+) 2 cases 5.7%. Thirty-five patients underwent surgery, including 30 cases of radical surgery, 5 cases of non-radical surgery and 10 cases of combined organ resection. The median follow-up time was 34 months and the follow-up rate was 100% (35/35). The cumulative survival rates at 1, 3 and 5 years of the whole group were 95.4%, 87.2% and 77.9% respectively. In this group of patients, 3 patients with postoperative recurrence and metastasis of patients taking imatinib mesylate are still tumor-bearing survival. The 5-year cumulative survival rate of patients with tumor size, with or without tumor necrosis, mitosis, tumor atherosclerosis, tumor location and surgical methods (P <0.05). Conclusion GIST is mainly diagnosed by postoperative pathology and immunohistochemistry, and complete local surgical resection is the most effective treatment. The patients with recurrent or metastatic disease need surgery and drug therapy.