Ludwig D J, Traverso L W
Section of General and Thoracic Surgery, Virginia Mason Medical Center, Seattle, Washington 98111, USA.
Am J Surg. 1997 May;173(5):390-4. doi: 10.1016/S0002-9610(97)00064-0.
Gut stromal tumors (GST) are a group of intramural intestinal tumors formerly known as leiomyoma and leiomyosarcoma. To improve the understanding of GST behavior, we posed the following questions: What are the clinical sequelae? Do size and symptoms correlate? What are the indications for excision?
A retrospective analysis (1988 to 1996) of the clinical course for GST patients was completed including long-term follow-up.
We found 39 patients with GST during the last 8 years. Their average age was 65 years and 59% were male. Tumors were found in the small bowel or stomach in 95% of cases. All patients were treated by surgical excision. Histologic grading yielded a benign diagnosis in 77%. Tumors were found incidentally at laparotomy in 41% and had an average size of 1.5 cm. In contrast, 59% of GST patients were symptomatic and the average size was 6 cm. In these 23 symptomatic patients, gastrointestinal bleeding occurred in 70%, of which acute hemorrhage was seen in 69-82% of them required transfusion and half required emergent operation. Additional findings in the symptomatic group included abdominal pain (57%), bowel obstruction (30%), and perforation (9%). An average long-term follow-up of 2.5 years was obtained in all patients (n = 34, 5 had died of other causes). Local recurrence was seen in 2 patients, metastatic disease in 2 other patients, and 30 (88%) were disease free. No patient with a GST discovered incidentally has had it recur.
Gut stromal tumors are uncommon yet cause significant patient morbidity. Small GST (<2 cm) were asymptomatic but larger GST were usually symptomatic. Most GST behaved in a benign fashion after local resection. Due to the frequency of serious complications in symptomatic patients, complete excision is recommended for GST, even if incidentally discovered.
胃肠道间质瘤（GST）是一组肠壁内肿瘤，以前称为平滑肌瘤和平滑肌肉瘤。为了更好地了解GST的行为，我们提出了以下问题：临床后遗症有哪些？大小与症状是否相关？切除的指征是什么？
完成了一项对GST患者临床病程（1988年至1996年）的回顾性分析，包括长期随访。
在过去8年中，我们发现了39例GST患者。他们的平均年龄为65岁，59%为男性。95%的病例中肿瘤位于小肠或胃。所有患者均接受手术切除。组织学分级显示77%为良性诊断。41%的肿瘤在剖腹手术中偶然发现，平均大小为1.5厘米。相比之下，59%的GST患者有症状，平均大小为6厘米。在这23例有症状的患者中，70%发生胃肠道出血，其中69%-82%出现急性出血，部分患者需要输血，半数患者需要急诊手术。有症状组的其他表现包括腹痛（57%）、肠梗阻（30%）和穿孔（9%）。所有患者（n = 34，5例死于其他原因）平均获得了2.5年的长期随访。2例出现局部复发，另外2例出现转移性疾病，30例（88%）无疾病复发。偶然发现的GST患者均未复发。
胃肠道间质瘤虽不常见，但会导致患者出现严重发病情况。小的GST（<2厘米）无症状，但较大的GST通常有症状。大多数GST在局部切除后表现为良性。由于有症状患者严重并发症的发生率较高，即使是偶然发现的GST，也建议完整切除。
