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目的:探讨胃间质瘤的临床特点,诊治经验和预后。方法:回顾性分析我院诊治的35例胃GIST病人的临床资料,并对临床特点、诊断、治疗以及预后进行报道,探讨该病复发转移的特点及影响预后的因素。结果:术前诊断正确率为68.6%肿瘤,中位直径7.0(1.5～14.0)cm。行胃楔形切除9例,胃部分切除23例,全胃切除3例;术后服用甲磺酸伊马替尼9例。CD117(+)100%,CD34(+)90.9%,Vim(+)79.3%,SMA(+)42.9%,S-100(+)26.9%。术后有6例出现复发转移,其中1例进行了再次手术。2例出现肝转移,3例后腹膜转移,1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≥5 cm、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,即使出现复发、转移,也应积极再次手术,同时高危和复发转移者应配合甲磺酸伊马替尼辅助治疗。
Objective: To investigate the clinical features, diagnosis and treatment experience and prognosis of gastric stromal tumors. Methods: The clinical data of 35 patients with gastric GIST diagnosed and treated in our hospital were retrospectively analyzed. The clinical features, diagnosis, treatment and prognosis were reported. The characteristics of the recurrence and metastasis and the prognostic factors were also discussed. Results: The accuracy of preoperative diagnosis was 68.6%. The median diameter was 7.0 (1.5-14.0) cm. 9 cases of gastric wedge resection, 23 cases of gastric partial resection, total gastrectomy in 3 cases; postoperative administration of imatinib mesylate in 9 cases. 100% of CD117 (+), 90.9% of CD34 (+), 79.3% of Vim (+), 42.9% of SMA and 26.9% of S-100 (+). Postoperative recurrence and metastasis in 6 cases, of which 1 case of reoperation. 2 cases had liver metastasis, 3 cases had peritoneal metastasis, 1 case had extensive peritoneal metastasis; 2 died and 4 cases had tumorigenicity. Univariate analysis found that tumor diameter ≥ 5 cm, mitotic figures ≥ 5/50 HPF and high-risk patients for gastric GIST recurrence and metastasis predictors. Conclusion: Patients with high risk of gastric GIST are more likely to have recurrence or metastasis after operation. Recurrence and metastasis should be actively followed up again. Patients with high risk and recurrence should be treated with imatinib mesylate adjuvant therapy.