低位直肠间质瘤治疗策略分析
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摘要
目的探讨低位直肠间质瘤的临床特征及治疗方法。方法回顾性分析32例接受手术治疗的低位直肠间质瘤病人的临床资料,按手术方法分为两组。接受Dixon及Miles手术的为扩大手术组,接受内镜下切除、经肛切除,经骶切除及经会阴切除者,为局部切除组。其中扩大切除组14例,局部切除组18例,比较两组的临床特征及术后复发转移情况。结果扩大切除组的手术时间是(152. 4±46. 2)分钟,出血量是(76. 1±36. 6) ml,肛门排气时间(3. 8±0. 6)天,住院时间(10. 2±1. 6)天;局部切除组分别是(54. 1±17. 9)分钟,(41. 1±20. 3) ml,(2. 9±0. 8)天和(6. 3±1. 3)天,两组比较差异均有统计学意义(P <0. 05)。两组间手术并发症,术后局部复发及远处转移比较,差异无统计学意义(P> 0. 05)。结论低位直肠间质瘤采用局部切除联合伊马替尼治疗未增加局部复发及远处转移的风险,但手术时间,出血量,住院时间显著降低,局部切除联合伊马替尼能明显减少创伤及改善病人生活质量。
Objective To study the clinical characteristics and treatment methods of the low rectal stromal tumor. Methods The clinical and follow-up data of 32 patients with low rectal gastrointestinal stromal tumor( GIST) were analysed. Paitents with Dixon and Miles operation were called group expanded resection( 14 cases),and patients with endoscopic resection,trans-anal,trans-sacral,trans-perineum resection were called group local resection( 18 cases). Compared the two groups with clinical characteristics and postoperative recurrence or metastasis. Results Operation time of group expanded resection was( 152. 4 ± 46. 2) min,while group local resection was( 54. 1 ± 17. 9) min,the blood loss of the two group was( 76. 1 ± 36. 6) ml and( 41. 1 ± 20. 3) ml,respectively; anus exhausting time of the two group was( 3. 8 ± 0. 6) d and( 2. 9 ± 0. 8) d,respectively; hospital stay of the two group was( 10. 2 ± 1. 6) d and( 6. 3 ± 1. 3) d,respectively( all P < 0. 05). There was no significant difference such as surgical complications,local recurrence and distant metastasis between the two groups. Conclusion Low rectal stromal tumor treated by local excision and imatinib did not increase the risk of local recurrence and distant metastasis,but the operation time,blood loss,hospitalization days significantly reduced,It is a safe and effective strategy to low rectal stromal tumor.
Objective To study the clinical characteristics and treatment methods of the low rectal stromal tumor. Methods The clinical and follow-up data of 32 patients with low rectal gastrointestinal stromal tumor( GIST) were analysed. Paitents with Dixon and Miles operation were called group expanded resection( 14 cases),and patients with endoscopic resection,trans-anal,trans-sacral,trans-perineum resection were called group local resection( 18 cases). Compared the two groups with clinical characteristics and postoperative recurrence or metastasis. Results Operation time of group expanded resection was( 152. 4 ± 46. 2) min,while group local resection was( 54. 1 ± 17. 9) min,the blood loss of the two group was( 76. 1 ± 36. 6) ml and( 41. 1 ± 20. 3) ml,respectively; anus exhausting time of the two group was( 3. 8 ± 0. 6) d and( 2. 9 ± 0. 8) d,respectively; hospital stay of the two group was( 10. 2 ± 1. 6) d and( 6. 3 ± 1. 3) d,respectively( all P < 0. 05). There was no significant difference such as surgical complications,local recurrence and distant metastasis between the two groups. Conclusion Low rectal stromal tumor treated by local excision and imatinib did not increase the risk of local recurrence and distant metastasis,but the operation time,blood loss,hospitalization days significantly reduced,It is a safe and effective strategy to low rectal stromal tumor.
引文
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[12]Hirota S,Isozaki K,Moriyama Y,et al.Gain-of-function mutations of c-kit in human gastrointestinal stromal tumors[J].Science,1998,279(3):577-580.
[13]Buchdunger E,Cioffi CL,Law N,et al.Abl protein-tyrosine kinase inhibitor STI571 inhibits in vitro signal transduction mediated by c-kit and platelet-derived growth factor receptors[J].J Pharmacol Exp T-her,2000,295(1):139-145.
[14]Rutkowski P,Gronchi A,Hohenberger P,et al.Neoadjuvant imatinib in locally advanced gastrointestinal stromal tumors(GIST):the EORTC STBSG experience[J].Ann Surg Oncol,2013,20(9):2937-2943.
[15]Wilkinson MJ,Fitzgerald JE,Strauss DC,et al.Surgical treatment of gastrointestinal stromal tumor of the rectum in the era of imatinib[J].Br J Surg,2015,102(8):965-971.
[2]中华医学会外科学分会胃肠外科学组.胃肠间质瘤规范化外科治疗专家共识[J].中国实用外科杂志,2015,35(6):593-598.
[3]Tran T,Davila JA,El-Serag HB.The epidemiology of malignant gastrointestinal stromal tumors:an analysis of 1,458 cases from 1992 to2000[J].Am J Gastroenterol,2005,100(1):162-168.
[4]Kameyama H,Kanda T,Tajima Y,et al.Management of rectal gastrointestinal stromal tumor[J].Transl Gastroenterol Hepatol,2018,3:8.
[5]Baik SH,Kim NK,Lee CH,et al.Gastrointestinal stromal tumor of the rectum:an analysis of seven cases[J].Surg Today,2007,37(6):455-459.
[6]万远廉,汤坚强,柳萍等.直肠间质瘤16例临床病理分析[J].中华外科杂志,2004,42(15):897-900.
[7]陈利生,何纯刚,梁君林.直肠间质瘤18例临床分析[J].中华胃肠外科杂志,2007,10(4):387-388.
[8]徐啸,彭佳远,徐梅玉.直肠间质瘤伊马替尼新辅助治疗后经肛门内镜显微手术切除[J].中国普通外科杂志,2015,24(10):1433-1438.
[9]Kaneko M,Nozawa H,Emoto S,et al.neoadjuvant imatinib therapy followed by intersphincteric resection for low rectal gastrointestinal stromal tumors[J].Anticancer Res,2017,37(9):5155-5160.
[10]Hawkins AT,Wells KO,Krishnamurty DM,et al.Preoperative chemotherapy and survival for large anorectal gastrointestinal stromal tumors:A national analysis of 333 cases[J].Ann Surg Oncol,2017,24(5):1195-1201.
[11]Mc Carter MD,Antonescu CR,Ballman KV,et al.Microscopically positive margins for primary gastrointestinal stromal tumors:analysis of risk factors and tumor recurrence[J].J Am Coll Surg,2012,215(1):53-59.
[12]Hirota S,Isozaki K,Moriyama Y,et al.Gain-of-function mutations of c-kit in human gastrointestinal stromal tumors[J].Science,1998,279(3):577-580.
[13]Buchdunger E,Cioffi CL,Law N,et al.Abl protein-tyrosine kinase inhibitor STI571 inhibits in vitro signal transduction mediated by c-kit and platelet-derived growth factor receptors[J].J Pharmacol Exp T-her,2000,295(1):139-145.
[14]Rutkowski P,Gronchi A,Hohenberger P,et al.Neoadjuvant imatinib in locally advanced gastrointestinal stromal tumors(GIST):the EORTC STBSG experience[J].Ann Surg Oncol,2013,20(9):2937-2943.
[15]Wilkinson MJ,Fitzgerald JE,Strauss DC,et al.Surgical treatment of gastrointestinal stromal tumor of the rectum in the era of imatinib[J].Br J Surg,2015,102(8):965-971.