腹膜后胃肠间质瘤外科处理策略

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需要从事软组织肉瘤研究的专业团队根据病人的不同病文章编号：1005-2208（2013）10-0853-03

期、治疗目标，对治疗的意义和治疗方案进行充分的评估和

讨论，为每个病人制定“量体裁衣”的个体化治疗方案，并在腹膜后胃肠间质瘤外科处理策略治疗过程中进行动态调整。姑息治疗不同于终末期病人的

处理，它应该是一种积极面对肿瘤挑战的治疗策略，经过有

效的治疗组合以使病人获得更好的症状控制和生活质量，何裕隆，张信华

甚至延长生存期。【摘要】胃肠间质瘤（gastrointestinalstromaltumor，GIST）参考文献是消化道最常见的间叶源性肿瘤。腹膜后GIST的生长类

型少见，没有固定术式，应该根据GIST手术原则，在充分准［1］LilesJS,TzengCW,ShortJJ,etal.Retroperitonealandintra-ab-

dominalsarcoma［J］.CurrProblSurg,2009,46(6):445-503.备的基础上，对应具体病例制定手术方案。结合靶向药物［2］CheifetzR,CattonC,KandelR,etal.Recentprogressinthe的术前辅助治疗，认真评估手术风险和收益，对提高手术

managementofretroperitonealsarcoma［J］.Sarcoma,2001,5(1):切除率，保存脏器功能，减少手术并发症至关重要。

17-26.【关键词】胃肠间质瘤；腹膜后；外科手术

［3］Yehjj,SingerS,BrennanMF,etal.Effectivenessofpalliative中图分类号：R6文献标志码：A

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2005,12(12):1084-1089.Surgicalmanagementofretroperitonealgastrointestinal［4］ShibataD,LewisJJ,LeungDH,etal.Istherearoleforincom-stromaltumorHEYu-long,ZHANGXin-hua.

pleteresectioninthemanagementofretroperitonealliposarco-DepartmentofGastrointestinalSurgery,FirstAffiliatedma?［J］.JAmCollSurg,2001,193(4):373-379.Hospital,SunYat-senUniversity,Guangzhou510080,China［5］NeuhausSJ,BarryP,ClarkMA,etal.SurgicalmanagementofCorrespondingauthor:HEYu-long,E-mail:YLH@medmail.

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timeterpermonthrule［J］.AnnSurg,2009,250(6):977-982.Retroperitonealmesenchymaltumorof

［7］StojadinovicA,LeungDH,AllenP,etal.Primaryadultsofttis-be

suesarcoma:time-dependentinfluenceofprognosticvariablesprincipalresectedonaGISTcase-to-caseisaspecialbasisgrowthgastrointestinalandbepattern,consistentwhichshouldtract.

［J］.JClinOncol，2002，20(21):4344-4352.adjuvant

［8］SoyferV,CornBW,KollenderY,etal.Radiationtherapyforpal-risktherapyofsurgeryininselectiveGIST.Combiningpatients,seriouslypreoperativewiththeevaluatingimatinibthe

liationofsarcomametastases:auniqueanduniformhypofrac-

tionationexperience［J］.Sarcoma,2010,2010:927972morbidityresectionandrate,benefitbetterofperseverationsurgeryarecrucialoforganinfunctionbringingandhigherlower

［9］KaravasilisV,SeddonBM,AshleyS,etal.SignificantclinicalKeywordsandgastrointestinalmortalityratesofstromalsurgery.tumor;retroperitoneum;

benefitoffirst-linepalliativechemotherapyinadvancedsoft-tis-surgery

suesarcoma:retrospectiveanalysisandidentificationofprognos-

ticfactorsin488patients［J］.Cancer,2008,112(7):1585.胃肠间质瘤（gastrointestinalstromaltumor，GIST）是消［10］VermaS,YounusJ,Stys-NormanD,etal.Ifosfamide-based化道最常见的间叶源性肿瘤。一般认为，其起源于Cajal间

combinationchemotherapyinadvancedsoft-tissuesarcoma:a质细胞（interstitialcellofCajal，ICC），或其多能前体细胞。practiceguideline［J］.CurrOncol,2007,14(4):144-148.ICC分布于胃肠道全程的肌间神经丛。真正的胃肠道外［11］SleijferS,OualiM,vanGlabbekeM,etal.Prognosticandpre-GIST（extra-GIST，EGIST）不超过1%［1-2］。腹膜后GIST是临

dictivefactorsforoutcometofirst-lineifosfamide-containing床的少见类型。真正起源于后腹膜的GIST属于EGIST，十chemotherapyforadultpatientswithadvancedsofttissuesarco-分罕见。文献［3-4］报道，EGIST还可见于网膜、肠系膜、胰mas:anexploratory,retrospectiveanalysisonlargeseriesfrom腺和膀胱。临床中更为常见的腹膜后GIST往往是来源于theEuropeanOrganizationforResearchandTreatmentofCan-

cer-SoftTissueandBoneSarcomaGroup(EORTC-STBSG)胃中上部后壁或起源于十二指肠降部和水平部的腔外生

［J］.EurJCancer,2010,6(1):72-83.长型GIST。前者可向后向下生长，影像学有时难与后腹膜

（2013-07-02收稿）来源肿瘤或左肾上腺肿瘤相鉴别。

作者单位：中山大学附属第一医院胃肠胰外科胃肠间质瘤

诊治中心，广东广州510080

通讯作者：何裕隆，E-mail：YLH@medmail.com.cn