Gheza F, Pulcini G, Cervi E, Ferrari A B, De Cesare V, Cervi G C
Clinica Chirurgica, Università degli Studi di Brescia.
G Chir. 2010 Jan-Feb;31(1-2):33-7.
Gastro-Intestinal Stromal Tumors (GISTs) represent an evolving field in oncological surgery and must be approached with specific prognostic and therapeutic criteria. In the GIST's suspicion the surgeon has to consider all the therapeutic possibilities, also for the impossibility to predict the biological behaviour and the aggressiveness of the tumor. The presence of a GIST has to be suspected in patients observed for gastrointestinal bleeding, when another pathology isn't demostrable. Surgical strategy must consider a limited resection as the best treatment, differently from what we do for adenocarcinoma. The extension of the resection can changes, regarding tumor volume and position, from extremely invasive surgery to laparoscopic operations with a partial removal of the gastric wall. Lymphadenectomy is not indicated because these tumors rarely spread to the nodes. We present the clinical case of two patients observed for gastrointestinal bleeding and with preoperative diagnostic suspicion of GIST, submitted to surgical resection. In the first case we performed a superior polar gastrectomy with esofago-gastric anastomosis for the mass proximity to the cardias. In the second patient the intervention has been a limited resection of the fundus of stomach including the tumor.
胃肠道间质瘤(GISTs)是肿瘤外科领域中一个不断发展的领域,必须采用特定的预后和治疗标准来处理。在怀疑为GIST时,外科医生必须考虑所有治疗可能性,因为无法预测肿瘤的生物学行为和侵袭性。当观察到患者有胃肠道出血且未发现其他病变时,必须怀疑存在GIST。手术策略必须将有限切除视为最佳治疗方法,这与我们对腺癌的处理方式不同。根据肿瘤体积和位置,切除范围可从极具侵袭性的手术到部分切除胃壁的腹腔镜手术不等。不建议进行淋巴结清扫,因为这些肿瘤很少转移至淋巴结。我们展示了两例因胃肠道出血而接受观察且术前诊断怀疑为GIST的患者的临床病例,他们均接受了手术切除。第一例患者因肿块靠近贲门,我们进行了食管胃吻合的近端胃切除术。第二例患者的手术是包括肿瘤在内的胃底有限切除术。