直肠来源胃肠道间质瘤的治疗策略分析

Analysis of treatment strategy for rectal gastrointestinal stromal tumors

摘要:

胃肠道间质瘤（GIST）是间叶组织来源肿瘤，可发生于全消化道，最常见于胃（60% ～ 70%）， 其次是小肠（20% ～ 30%），只有5%GIST 起源于直肠。手术治疗一直是可切除直肠GIST 的首选治疗方式， 传统采用低位前切除和腹会阴联合切除等术式、切除范围广，对患者生活质量造成一定影响。随着研究的深入， GIST 罕见发生淋巴结转移，使得直肠GIST 存在经肛门、经骶尾和经阴道入路进行局部切除的可能。该类术 式创伤更小，对解剖结构和脏器功能不造成破坏。近年来，随着分子靶向药物不断研发上市，术前缩小肿瘤体 积，使越来越多的直肠GIST 可以实现局部R0 切除。但由于直肠GIST 发病率低，关于直肠GIST 的治疗策 略有待进一步研究与探讨。

Abstract:

Gastrointestinal stromal tumor (GIST) is a mesenchymal tissue-derived tumor that can occur in the whole digestive tract, most commonly in the stomach (60% ～ 70%), followed by the small intestine (20% ～ 30%), and only 5% in the rectum. Surgical treatment has always been the preferred treatment for rectal GIST. Traditionally, low-position anterior resection and abdominal perineal resection have been used, and the scope of resection is wide, which may cause a certain impact on the quality of patients’ life. With the deepening of the research, it has been reported that GIST rarely metastasizes to lymph node, which makes it possible for the rectal GIST to undergo local resection through the anus, the transsacral and the transvaginal approach. This type of surgical procedure has less trauma and does not cause significant damage to anatomical structures and organ function. In recent years, as molecular targeted drugs have been continuously developed and have been on the market, the tumor volume has been reduced before surgery. Therefore, more and more rectal GIST can achieve local R0 resection. However, due to the low incidence of rectal GIST, the treatment strategy for rectal GIST needs further research and discussion.