中国实用外科杂志

中国实用外科杂志

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十二指肠间质瘤手术治疗选择策略（附34例报告）

吴晓燕，刘    刚，刘    健，刘    彤   

  1. 天津医科大学总医院普通外科，天津300052
  • 出版日期:2015-09-01 发布日期:2015-08-28

  • Online:2015-09-01 Published:2015-08-28

摘要：

目的    探讨十二指肠间质瘤（gastrointestinal stromal tumor，GIST）的临床特点及手术方式选择。方法　回顾性分析天津医科大学总医院2009年1月至2014年12月经手术治疗的34例十二指肠GIST病人的临床病理资料和随访资料，就行局限性切除术（limited resection，LR）26例、胰十二指肠切除术（pancreaticoduodenectomy，PD）8例两种术式选择依据及临床预后进行分析。结果    PD较LR术中出血量、肿瘤大小、并发症发生率、术后无复发存活率以及肿瘤危险度分级差异无统计学意义（P＞0.05）；LR较PD手术时间［（185±102）min vs.（420±135）min］、术后住院时间［（24±15） d vs.（33±16）d］明显缩短，差异有统计学意义；PD的选择与肿瘤系膜侧边缘距十二指肠乳头的位置及是否侵犯胰腺有关。结论    十二指肠GIST手术方式主要取决于肿瘤系膜侧边缘距乳头的位置及是否侵犯胰腺，在肿瘤系膜侧边缘距乳头位置＞2 cm且无胰腺侵犯的前提下LR手术应作为治疗的首选。

关键词: 十二指肠, 胃肠道间质瘤, 胰十二指肠切除术, 局限性切除术, 术式选择

Abstract:

Surgical strategies of duodenal gastrointestinal stromal tumor：A report of 34 cases        WU Xiao-yan, LIU Gang, LIU Jian, et al. Department of General Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
Corresponding author: LIU Tong, E-mail: liutonga@126.com
Abstract    Objective    To explore the clinical features and selective surgical procedures for duodenal gastrointestinal stromal tumor (GIST). Methods    The clinical pathological data and follow-up data of 34 cases of duodenal GIST performed surgery from January 2009 to December 2014 in Tianjin Medical University General Hospital were analyzed retrospectively. All the cases were performed surgical resection，including 8 cases of pancreaticoduodenectomy (PD) and 26 cases of limited resection (LR). Related clinical information between PD and LR groups were compared by statistical analysis. Results    There was no statistical difference in intraoperative blood loss, tumor size, complication incidence, postoperative recurrence free survival and tumor risk classification between PD and LR group. LR was significantly associated with a shorter operation time and a shorter hospital stay compared to PD [（185±102）min vs.（420±135）min；（24±15）d vs.（33±16）d]. The choice for PD depends on the tumor margin away from the position of duodenal papilla and involvement of the pancreas. Conclusion    Operative procedure of duodenal GIST depends on the tumor margin away from the duodenal papilla and involvement of the pancreas. If the tumor margin is greater than 2 cm away from duodenal papilla and without pancreatic invasion, LR would be the preferred choice of operative procedure.

Key words: duodenum, gastrointestinal stromal tumor, pancreaticoduodenectomy, limited resection, surgical procedures selection