Sanchez Barry R, Morton John M, Curet Myriam J, Alami Ramzi S, Safadi Bassem Y
Stanford University Medical Center, Stanford, CA 94305-5655, USA.
Obes Surg. 2005 Nov-Dec;15(10):1384-8. doi: 10.1381/096089205774859326.
Gastrointestinal stromal tumors (GISTs) are rare tumors, accounting for <1% of all neoplasms of the alimentary tract. GISTs have not been previously reported in association with gastric bypass surgery.
This study is a retrospective review of 517 consecutive morbidly obese patients who underwent laparoscopic Roux-en-Y gastric bypass (LRYGBP) between January 2002 and August 2005. Incidental intraoperative findings of gastric GIST were recorded.
4 patients (0.8%) were noted to have GISTs intra-operatively upon inspection of the stomach prior to partition. All GISTs were identified along the anterior aspect of the upper third of the stomach and were removed by laparoscopic wedge excision with at least a 1 cm margin. The 4 tumors were <1 cm in size and all had immunohistochemical analysis positive for CD117 (c-kit). None of the tumors had determinants of malignant behavior (high mitotic rate, necrosis or pleomorphism).
We have found a 0.8% incidence of gastric GISTs in our morbidly obese patients undergoing LRYGBP. All of these small, benign tumors were found incidentally in asymptomatic patients. This case series underscores the need to fully assess the stomach prior to gastric pouch formation. Without the ability to grossly determine the benign or malignant behavior of GISTs, all these tumors found incidentally should be resected with adequate margins.
胃肠道间质瘤（GISTs）是罕见肿瘤，占消化道所有肿瘤的不到1%。此前尚未有GISTs与胃旁路手术相关的报道。
本研究是对2002年1月至2005年8月期间连续接受腹腔镜Roux-en-Y胃旁路手术（LRYGBP）的517例病态肥胖患者的回顾性研究。记录术中偶然发现的胃GISTs情况。
4例患者（0.8%）在胃分隔前检查时术中发现患有GISTs。所有GISTs均位于胃上三分之一的前壁，通过腹腔镜楔形切除术切除，切缘至少1 cm。这4个肿瘤大小均小于1 cm，免疫组化分析CD117（c-kit）均呈阳性。所有肿瘤均无恶性行为的特征（高有丝分裂率、坏死或多形性）。
我们发现在接受LRYGBP的病态肥胖患者中，胃GISTs的发生率为0.8%。所有这些小的良性肿瘤均在无症状患者中偶然发现。该病例系列强调了在胃囊形成前对胃进行全面评估的必要性。由于无法大体判断GISTs的良恶性行为，所有偶然发现的这些肿瘤均应进行足够切缘的切除。
