目的：评价伊马替尼新辅助治疗结合经肛门内镜显微手术（TEM）局部切除治疗直肠间质瘤（GIST）的疗效和安全性。方法：入组13 例直肠GIST 患者，先予以伊马替尼治疗30~90 d，肿瘤退缩后予以TEM 局部切除肿瘤，分析患者术前临床病理资料、新辅助治疗反应性及相关手术指标。结果：接受伊马替尼新辅助治疗3 个月内所有患者均出现缓解，肿瘤降期显著。所有患者除1 例改行腔镜下经腹直肠局部切除外，均行TEM 局部切除，其中9 例的患者（70%）在接受伊马替尼治疗2 个月内进行手术。平均手术时间45 min，平均术后住院时间6.7 d。11 例患者（85%）手术出血少于20 mL，无术后严重出血或感染病例。无治疗相关死亡或其他严重不良事件。12 例TEM 患者随期无复发或死亡。结论：部分局部进展期直肠GIST，伊马替尼新辅助治疗后结合TEM 能够获得理想的手术效果，安全性高，手术创伤小，是一种可选择的治疗方式。
Neoadjuvant imatinib therapy followed by transanal endoscopic microsurgery for local excision of gastrointestinal stromal tumor of the rectum: a report 13 cases
Objective: To assess the efficacy and safety of neoadjuvant imatinib therapy followed by transanal endoscopic microsurgery (TEM) for local excision of gastrointestinal stromal tumor (GIST) of the rectum. Methods: A group of thirteen patients with rectal GIST received imatinib therapy for 30-90 d and, after tumor regression, underwent TEM local excision of the tumor. The preoperative clinicopathologic profiles, response to neoadjuvant therapy, and relevant surgical variables of the patients were analyzed. Results: Remission was achieved in all patients within 3 months of neoadjuvant imatinib therapy, and significant tumor down-staging was seen. All patients, except one case that was converted to laparoscopic local rectal excision, received TEM local excision, of which 9 cases (70%) received operation after less than 2 months of neoadjuvant imatinib therapy. The average operative time was 45 min, and length of postoperative hospital stay was 6.7 d. The intraoperative blood loss in 11 patients (85%) was less than 20 mL, and no severe postoperative blood loss or infection occurred in any of the patients. No treatment-related death or other severe adverse reaction occurred. During follow-up, no recurrence or death occurred in the 12 patients undergoing TEM local excision. Conclusion: For some cases with locally progressive rectal GIST, preoperative imatinib therapy followed by TEM treatment can achieve favorable outcomes with high safety and minimal trauma, so it can be considered as a treatment option.