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目的探讨甲磺酸伊马替尼联合手术治疗晚期转移性胃肠道间质瘤(GIST)的临床效果。方法选择2007年10月-2010年11月间30例转移性GIST患者,所有患者均在术前接受甲磺酸伊马替尼治疗,对患者行完全切除、主要病灶清除术和姑息减瘤术三种不同的手术,在治疗后对患者进行随访。结果较全面控制和局部控制组中有80%是已经行肿瘤完全切除和较满意的主要病灶清除术。手术相关并发症发生肠梗阻、肠瘘、腹腔出血均为2例。肿瘤完全切除的患者术后无进展生存期优于其他两种手术方式,但差异无统计学意义(P>0.05)。控制不足组的患者中位无进展生存期为3个月,其他两组的患者中位无进展生存期26个月(P<0.05)。控制不足组患者中位总生存期11个月,其他两组患者术后一直存活到现在(P<0.05)。结论靶向治疗后,对晚期转移性GIST患者行手术治疗的安全性方面,较全面控制组和局部控制组患者的安全性较高,而控制不足组的患者应该谨慎对待。
Objective To investigate the clinical efficacy of imatinib mesylate in the treatment of advanced metastatic gastrointestinal stromal tumors (GIST). Methods Thirty cases of metastatic GIST from October 2007 to November 2010 were selected. All patients received imatinib mesylate preoperatively. The patients underwent complete resection, major lesion removal and palliative tumor reduction Three different procedures were followed up after treatment. The results of more comprehensive control and local control group, 80% of the tumor has been completely removed and more satisfied with the main lesion removal. Surgical complications associated with intestinal obstruction, intestinal fistula, abdominal bleeding were 2 cases. Patients with complete tumor resection had better progression-free survival than the other two methods, but the difference was not statistically significant (P> 0.05). The median progression-free survival was 3 months in the under-control group and 26 months in the other two groups (P <0.05). The median overall survival was less than 11 months in the under-control group, and the other two groups survived until now (P <0.05). Conclusions After targeted therapy, the safety of surgical treatment in patients with advanced metastatic GIST is more secure than that in patients in the complete and partial control groups, and patients in the less controlled group should be treated with caution.