Objective To assess the safety and efficacy of laparoscopic resection for gastric stromal tumors. Methods The Literature published before November of 2010 was searched in PubMed, EMbase, Wiley Online Library, MEDLINE, CNKI, VIP, and CBM to identify the randomized controlled trials (RCTs) or quasi-RCTs about laparoscopic versus open resection for gastric stromal tumors. The literature was screened according to the inclusive and exclusive criteria by two reviewers independently, and the methodology quality was evaluated after abstracting the data, then the RevMan 5.0 software was used for Meta-analyses. Results Four quasi-RCTs and eight CCTs involving 496 patients were included. The results of Meta-analyses showed that, compared with the open resection surgery, the laparoscopic resection surgery significantly reduced the hospitalization duration (MD= –2.81, 95%CI –4.51 to –1.11), and the incidence of recurrence and metastasis (OR=0.36, 95%CI 0.13 to 1.01). No significant differences were found between the two groups in operation time, amount of bleeding, postoperative first flatus and oral intake, and total complication rate (Pgt;0.05). Conclusion Laparoscopic resection surgery is safe to treat the patients with gastric stromal tumors, which may reduce the hospitalization duration and the incidence of recurrence and metastasis. Due to the poor quality and small sample size of included trials, more well-designed RCTs should be performed.
【摘要】 目的 总结胃间质瘤的诊断及治疗方法。 方法 回顾性分析2005年10月-2009年10月收治的15例胃间质瘤患者的临床资料。 结果 患者的主要临床表现为消化道出血、腹痛、腹胀、贫血等，全部手术切除。主要根据胃间质瘤大小和部位决定手术方式。有6例行胃大部切除，8例行胃楔形切除，1例经腹腔镜行胃楔形切除。 结论 胃间质瘤术前难以明确诊断，确诊有赖于术后病理和免疫组织化学检查，手术切除仍是治疗胃间质瘤的主要手段。【Abstract】 Objective To summarize the clinical experience in diagnosing and treating gastric stromal tumor. Methods The clinical data of 15 patients with gastric stromal tumor admitted from October 2005 to October 2009 was retrospectively reviewed. Results Among these patients, the clinical manifestations mainly included gastrointestinal bleeding, abdominal pain, abdominal flatulence, and anemia. All patients had undergone surgical resections. Mainly based on the size and location of the gastric stomal tumor, a specific operative procedure was decided for each patient. Of these patients, subtotal gastrectomy had been performed on six, gastric wedge resection on eight, and laparoscopic gastric wedge resection on one. Conclusion It is difficult to confirm the diagnosis of gastric stromal tumor before the operation. The diagnosis is usually confirmed by postoperative pathological and immunohistochemical examinations. Surgical resection remains to be the major therapeutic approach for gastric stromal tumor.
目的:探讨胃间质瘤的诊断和治疗方法。方法:对19例经手术治疗的胃间质瘤的临床资料进行回顾分析。 结果:近端胃切除2例,远端胃切除5例,胃楔形切除12例。全组无围手术期死亡,术后无主要并发症。术后复发2例,5年生存率为47％。结论:胃间质瘤缺乏特征性的临床表现,确诊依赖病理和免疫组化检查结果,手术切除是治疗的主要方法。
Objective To explore the value of laparoscopy combined with gastroscopy in treatment for gastric stromal tumors. Method The clinical data of 45 patients with gastric stromal tumors performed laparoscopy combined with gastroscopy resection from June 2008 to June 2012 in this hospital were analyzed retrospectively. Results Forty-five patients with gastric stromal tumors were successfully excised by laparoscopy combined with gastroscopy， and the tumors were completely resected and no residual tumor at the edge. The length of surgical incision was about 4-6 cm with an average of 5.1 cm. The mean operation time was 75 min. Postoperative recovery was smooth， no surgery-related comp-lications occurred. The mean hospital stay was 6.8 d. No recurrence or metastasis happened within the follow-up with an average of 16.5 months. The immunohistochemical examination results：43 cases of CD117 was positive， 32 cases of CD34 was positive， 28 cases of SMA was positive， 2 cases of Desmin was positive， 22 cases of S-100 was positive. Conclusions The treatment of gastric stromal tumors through laparoscopy combined with gastroscopy is safe and effective. The benefits include minimal invasiveness， shorter operation time， and rapid postoperative recovery. The laparoscopy combined with gastroscopy can make more precise resection range， and avoid residual tumor and resection of excessive normal gastric tissue.
Objective To investigate the clinical characteristics， diagnosis， and treatment of gastric stromal tumor. Methods Clinical data of 217 patients with gastric stromal tumor from October 2007 to July 2011 were analyzed. Results The main clinical manifestation were abdominal pain， abdominal distension， bloody stools， abdominal mass， and so on. The tumour located at cardiac part， fundus of stomach， body of stomach， and pylorus part was 24 cases （11.0%）， 103 cases （47.5%）， 59 cases （27.2%）， and 31 cases （14.3%）， respectively. All the 217 patients underwent endoscopic or surgical resection and diagnosed by pathology and immunohistochemistry. The patients of high-low risk， low risk， intermediate risk， and high risk was 56 cases （25.8%）， 67 cases （30.9%）， 41 cases （18.9%）， and 53 cases （24.4%）， respectively. One hundred and forty patients were followed-up for 7-52 months （average 35 months）. Thirty-five patients of high risk were investigated about the drug treatment after the first operation：19 cases were treated by using imatinib （tumor progressed in 2 cases） and 16 patients were not （tumor progressed in 9 patients）. The rate of progression of patients treated by imatinib was significantly lower than another group （χ2=8.426， P=0.004）. In 11 patients with tumor progressed， tumor recurrnce in 4 cases， tumor recurrence with diffused abdominal cavity metastasis in 1 case， tumor metastasized to humerus in 1 case， metastasized to liver and abdominal cavity in 1 case， and metastasized to liver in 4 cases. Conclusions Gastric stormal tumor is lack of specific clinical manifestations. Complete excision of the tumor is the main therapy method， and imatinib can improve prognosis.
Objective To discuss the value of 64-slice spiral CT （MSCT） in diagnosis of gastric stromal tumor （GST）. Methods Thirty-two patients proved GST by surgery and pathology from May 2010 to August 2011 in West China Hospital, Sichuan University were classified by Fletcher malignancy degree classification，the CT features including the location，size，boundary，shape，density，growth pattern，metastases，and enhancement and its relationships to GST malignancy degree were analyzed retrospectively. Results All 32 cases were single lesion，the accuracy of CT in localization was 100%. Nine cases were intra-luminal，10 were extra-luminal，and 13 were both intra- and extra-luminal growth. Nine cases were in low degree group，with diameter＜5cm，round or oval in shape，clear border, homogenous density and enhancement （7/9）；Twenty-three cases were in high degree group，with diameter ≥5cm in 19 cases，irregular in shape and indistinct bourdry （18/23），heterogeneous density （20/23） with necrosis，ulcer was seen in 6 cases. Three cases in high malignance degree group showed pancreas and spleen involvements，2 cases of left diaphragm involvement，1 of omentum metastasis，2 of liver metastases，and 1 of lymph node metastasis. Conclusions MSCT is the optimal method to exam GST，there is correlation between the CT features and malignancy degree，MSCT is helpful for analyzing malignancy degree preoperation.
Objective To discuss the clinical application of totally laparoscopic surgery combined with intraoperative removed the specimen through the oral in treatment for gastric stromal tumor. Methods The clinical data of 20 patients diagnosed gastric stromal tumor and performed totally laparoscopic surgery combined with intraoperative removed the specimen through the oral in treatment for gastric stromal tumor from January 2007 to August 2009 in our hospital were analyzed retrospectively. Results All the cases were performed successfully laparoscopic operation. The operation time was （110±35） min， intraoperative bleeding was （60±15） ml，postoperative hospital stay was （6.5±1.2） d. No postoperative complications occurred. There were 19 cases no relapse during 0.5-2.5 years with (1.8±0.2) years of follow-up. One patient with recurrence was performed the laparoscopic proximal subtotal gastrectomy. Conclusions Totally laparoscopic surgery combined with intraoperative removed the specimen through the oral in treatment for gastric stromal tumor is safe， feasible， and minimally invasive for patients due to its clearness of dissection， less bleeding， and removed the specimen through natural channel.
目的探讨经脐单孔腹腔镜联合胃镜治疗微小胃间质瘤(gastric stromal tumors, GIST)的可行性和临床疗效。 方法回顾性分析我院2010年10月至2011年5月期间行经脐单孔腹腔镜联合胃镜治疗微小GIST 30例患者的临床资料。 结果30例病灶直径（1.0±0.2） cm（0.5～2.0 cm），术后病理检查均证实为极低危险程度GIST。 24例在单孔腹腔镜辅助下成功完成内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）； 3例因ESD术中发生胃壁穿孔而改行内镜全层切除术（endoscopic full-thickness resection, EFR），其中2例继续在单孔下完成穿孔修补术，1例于左上腹壁另加一 Trocar，在双孔下完成穿孔修补术； 另3例因ESD剥离瘤体困难，改行胃局部切除术，其中2例继续在单孔下完成手术，1例在双孔下完成手术。 ESD成功率为80.0%（24／30），经脐部单孔完成率为93.3%（28/30）。手术时间（87.5±10.3） min （45～150 min）。 全组术后（4.3±0.5） d （3～8 d）出院。术后随访期3～7个月（平均4.6个月），均无病变复发。 结论经脐部单孔腹腔镜联合胃镜治疗微小GIST是安全可行的，早期疗效令人满意。