Mihssin N, Moorthy K, Sengupta A, Houghton P W
Department of Surgery, Torbay Hospital, Torquay, UK.
Ann R Coll Surg Engl. 2000 Nov;82(6):378-82.
Recent findings on the pathological diversity of gastric stromal tumours and their unpredictable behaviour prompted us to review our series of 16 patients who had undergone surgery for these tumours from 1991 to 1998. There were 13 benign and 3 malignant lesions. The majority of patients presented with either upper gastrointestinal bleeding or anaemia alone (12 of 16). Endoscopy was an extremely useful diagnostic tool, revealing the lesion as an intraluminal protuberant tumour with or without ulcer in 10 cases and as an ulcer alone in 4 cases, and in 1 case features suggesting an extrinsic mass. All the patients in the series underwent surgery. We used staplers (AutosutureR TA 55) to excise the tumours in 7 cases, all of which on histological examination were benign with clear resection margins. Gastric resections were performed in 5 cases for either large tumours or those situated at the fundus or antrum and local excision of the remaining 4. The mean follow-up of these patients was 24 months. Two patients with malignant lesions died of irresectable recurrences, one 2 months and one 18 months after surgery. There have been no recurrences in the tumours diagnosed as benign on histology. Tumour size, position and the ability to apply the stapler leaving adequate margin below the tumour should be the determinants of extent and type of excision. Reliable determinants of behaviour are tumour size, grade and mitotic index.
近期关于胃间质瘤病理多样性及其不可预测行为的研究结果促使我们回顾了1991年至1998年间接受此类肿瘤手术的16例患者。其中有13例良性病变和3例恶性病变。大多数患者仅表现为上消化道出血或贫血（16例中有12例）。内镜检查是一种极其有用的诊断工具，10例显示病变为腔内突出性肿瘤，伴有或不伴有溃疡，4例仅显示为溃疡，1例表现为提示外在肿块的特征。该系列所有患者均接受了手术。我们使用吻合器（AutosutureR TA 55）切除了7例肿瘤，所有这些肿瘤经组织学检查均为良性，切缘清晰。5例因肿瘤较大或位于胃底或胃窦而进行了胃切除术，其余4例行局部切除术。这些患者的平均随访时间为24个月。两名患有恶性病变的患者死于无法切除的复发，分别在术后2个月和18个月。经组织学诊断为良性的肿瘤无复发。肿瘤大小、位置以及使用吻合器在肿瘤下方留出足够切缘的能力应是切除范围和类型的决定因素。肿瘤行为的可靠决定因素是肿瘤大小、分级和有丝分裂指数。
