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目的分析胃肠道间质瘤(GIST)外科治疗效果及其影响因素。方法对1990年1月至2006年3月收治的153例 GIST 的临床资料和病理切片(含免疫组化检查)重新复核并加以随访,着重分析手术切除的效果以及影响手术疗效的因素。结果本组中位生存时间为60.0个月,术后1、2、3、4和5年生存率分别为94.9%、83.3%、73.3%、70.5%和64.3%。完全切除术组患者生存率明显优于不完全切除术组(P=0.00),后者仅2例生存期超过2年。完全切除术组中,肿瘤局部切除和肿瘤及所在器官切除患者生存率之间比较,差异无统计学意义(P>0.05);但肿瘤局部切除或肿瘤及所在器官切除两组分别与扩大切除术者比较,差异有统计学意义(P<0.05)。完全切除术患者的牛存率与其性别、肿瘤部位和大小、肿瘤性质、核分裂及复发转移有关;但多因素的 Cox 回归分析显示,术后生存率仅与肿瘤大小、肿瘤性质和复发转移相关(P<0.05)。结论 GIST 仍应以外科治疗为主,原则上施行局部完全切除即可,广泛切除或扩大淋巴结清扫不能提高生存率。
Objective To analyze the surgical treatment of gastrointestinal stromal tumors (GIST) and its influencing factors. Methods The clinical data and pathological sections (including immunohistochemistry) of 153 cases of GIST admitted from January 1990 to March 2006 were reviewed and followed up. Emphasis was placed on the effect of surgical resection and the factors influencing the curative effect of GIST. Results The median survival time was 60.0 months. The postoperative 1,2,3,4 and 5-year survival rates were 94.9%, 83.3%, 73.3%, 70.5% and 64.3%, respectively. Survival of patients in the complete resection group was significantly better than that in the group of incomplete resection (P = 0.00), while the latter 2 patients survived for more than 2 years. In the complete resection group, there was no significant difference between the tumor excision and the survival rate of the tumor and the organ excision (P> 0.05). However, there were no significant differences between the two groups The difference was statistically significant (P <0.05). The survival rate of patients undergoing total resection was related to their sex, tumor location and size, tumor nature, mitosis and recurrence and metastasis; however, Cox regression analysis showed that postoperative survival rate was only related to tumor size, tumor characteristics and recurrence and metastasis P <0.05). Conclusion GIST should still be mainly surgical treatment, in principle, the implementation of partial resection can be a total removal or expansion of lymph node dissection can not improve the survival rate.