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目的:探讨巨大胃肠道间质瘤(GIST)的临床特征、诊断治疗方法及预后。方法:回顾性分析2012年1月—2015年4月间在川北医学院附属医院收治的179例GIST患者资料,其中39例为巨大GIST(直径≥10 cm)。结果:39例巨大GIST患者的发病部位分别为胃部14例(35.6%)、消化道外(肠系膜、网膜、腹膜)10例(25.6%)、回肠7例(17.9%)、空肠4例(10.3%)、十二指肠3例(7.7%)、直肠1例(2.6%);与普通GIST(直径<10 cm)比较,巨大GIST患者中核分裂像、包膜破损、多发、胃肠道外GIST、术前贫血及并发症比例明显增高(均P<0.05)。39例患者中,单纯性肿瘤切除8例(20.5%),合并胃肠等器官部分切除30例(76.9%),1例(2.6%)肿瘤未能切除;39例巨大GIST均为高危风险度,32例患者获得有效随访,4例(10.3%)术后服用伊马替尼治疗;术后1、2年无进展生存率分别为92.8%、79.6%。结论:巨大GIST可根据临床表现、影像学及病理检查结果诊断,其临床特征表现出较高的危险度,完整肿瘤切除合并胃肠等器官部分切除以及规范的术前与术后靶向治疗是改善患者预后的有效手段。
Objective: To investigate the clinical features, diagnosis, treatment and prognosis of giant gastrointestinal stromal tumors (GIST). Methods: The data of 179 GIST patients admitted to the Affiliated Hospital of North Sichuan Medical College from January 2012 to April 2015 were retrospectively analyzed. Among them, 39 were giant GIST (diameter ≥10 cm). Results: Thirty-nine patients with giant GIST had gastric lesions in 14 cases (35.6%), gastrointestinal (mesentery, omentum and peritoneum) in 10 cases (25.6%), ileum in 7 cases (17.9%) and jejunum in 4 cases 10.3%), three cases of duodenum (7.7%) and one case of rectum (2.6%). Compared with common GIST (diameter <10 cm), mitotic figures, GIST, preoperative anemia and complications were significantly increased (all P <0.05). Of the 39 patients, 8 (20.5%) had simple excision of the tumor, 30 (76.9%) had partial resection of the gastrointestinal tract, 1 had tumor resection (2.6%), and 39 of the large GISTs were at high risk , 32 patients were effectively followed up and 4 (10.3%) patients were treated with imatinib. The progression-free survival at 1 year and 2 years after operation was 92.8% and 79.6% respectively. Conclusions: Giant GIST can be diagnosed based on clinical manifestations, imaging and pathological findings, and its clinical features show a high risk. Partial resection of complete tumor resection combined with gastrointestinal and other organs and standardized preoperative and postoperative targeted therapy are Effective means to improve the prognosis of patients.