胃肠道间质瘤非同期肝转移治疗.docVIP

胃肠道间质瘤非同期肝转移的治疗 　　摘要：目的 总结胃肠道间质瘤非同期肝转移的诊断及治疗经验。方法 回顾性分析13例胃肠道间质瘤非同期肝转移的临床资料。结果 本组13例，均为胃肠道间质瘤术后发现有肝转移，同时并复发或其他部位转移。其中8例来源于胃，2例位于十二指肠，1例位于空肠，2例位于结肠。临床表现均有肝功能不同程度受损：Child-pugh分级A级3例，B级6例，C级4例。2例并局部复发，1例并腹腔转移，1例并腹膜后转移。本组均行甲磺酸伊马替尼治疗，4例术前行介入治疗（TACE），3例行射频治疗，9例行手术治疗。本组13例均获随访，1年生存率84.6%，3年生存率53.8%。结论 靶向治疗加手术切除、TACE、射频的综合治疗是治疗本类患者最有效的治疗方法 关键词：胃肠道间质瘤；肝转移；甲磺酸伊马替尼；手术 Abstract：Objective To evaluate diagnosis and treatment of liver metastasis gastrointestinal stromal tumor（GIST）than the same period.Methods The clinic data of 13 patients with liver metastasis gastrointestinal stromal tumor than the same period was analyzed retrospectively.Results In all 13 patients，both in postopretive gastrointestinal stromal tumor liver metastases，8 cases had the primary tumor in stomach，2 case in duodenum，1 case in jejunum，2 case in colon.Clinic manifestations were liver funcyion is affected by different level：Child-pugh，class A in 3 cases，class B in 6 cases，class C in 4 cases.Post-operative recurrence or metastasis occurred in all cases，including tumor recurrence and metastasized to liver tissues in 2 cases，metastasized to liver tissues in 4 cases，metastasized to liver and abdominal cavity in 1 case，metastasized to liver and retropetitoneal cavity in 1 case.All patients recepted follow-up views13 cases had taken imatinib mesylate，4 cases of preoperative accepted interventional therapy（TACE），9 cases recepted surgical treatment，3 cases accepted Radiofrequency ablation.1-year survival rates were 84.6%and 3-year were 53.8%.Conclusion Targeted therapy and surgery，TACE，radio frequency integrated treatment is the most effective treatment for it. Key words：GIST；Liver Metastases；Imatinib mesylate；Operation 胃肠道间质瘤（gastrointestinal stromal tumor，GIST）是消化道最常见的间叶源性肿瘤，占消化道肿瘤的1%～3%[1]。据报道，有超过50%的胃肠道间质瘤在手术切除后会出现复发和转移[2]，肝转移是胃肠道间质瘤转移的主要器官。其分子生物学特点是c-kit基因突变，使络氨酸激酶受体持续活化，导致肿瘤细胞得以持续增殖。然而，络氨酸激酶抑制剂-甲磺酸伊马替尼等的出现，打断了肿瘤细胞的增殖，使本类患者获益 1资料与方法 1.1一般资料 2000年3月～2015年1月就诊于我院GIST伴非同期肝转移患者13例。其中男7例，女6例。患者年龄41