目的　加深对胃平滑肌肉瘤的认识 ,提高诊治水平。方法　对 5例胃平滑肌肉瘤的临床资料及误诊原因进行分析。结果　 5例中 ,1例术前误诊为腹膜后神经纤维瘤、肠系膜肿瘤 ;1例单纯诊断直肠癌 ;1例术前误诊为结肠脾区肿瘤、腹膜后肿瘤 ;1例术前误诊为胰腺肿瘤 ;1例术前误诊为结肠肿瘤。术后全部确诊 ,均行肿瘤及胃大部切除。结论　胃平滑肌肉瘤症状无特征性 ,确诊需病理检查。全面细致的检查有助于该病的正确诊断 ;对上腹部包块患者应积极实施剖腹探查 ,以减少误诊。本病对化疗、放疗不敏感 ,手术治疗为首选治疗方法 Objective To deepen the understanding of gastric leiomyosarcoma and improve the diagnosis and treatment. Methods The clinical data of 5 cases of gastric leiomyosarcoma and the causes of misdiagnosis were analyzed. Results Of the 5 cases, 1 patient was misdiagnosed as retroperitoneal neurofibroma and mesentery before surgery, 1 patient was diagnosed as rectal cancer, 1 patient was misdiagnosed as colon and splenic tumor and retroperitoneal tumor before operation, 1 patient was misdiagnosed as pancreatic neoplasm One case was misdiagnosed as colon cancer before operation. All diagnosed after surgery, both tumor and gastrectomy. Conclusion The symptoms of gastric leiomyosarcoma without characteristic, the diagnosis required pathological examination. Comprehensive and meticulous examination will help the correct diagnosis of the disease; patients with upper abdominal mass should be actively exploited laparotomy to reduce misdiagnosis. The disease is not sensitive to chemotherapy, radiotherapy, surgical treatment is the preferred method of treatment