大肠间质瘤13例临床分析

Clinical Analysis of Large Intestinal Stromal Tumors

目的 :探讨大肠间质瘤的诊断及治疗。方法 :回顾性分析 13例大肠间质瘤的病历资料 ,男 9例 ,女 4例 ,结肠 2例 ,直肠 8例 ,肛管 3例。良性 1例 ,潜在恶性 2例 ,恶性 10例。结肠间质瘤表现为腹块、腹痛、肠梗阻等 ,直肠肛管间质瘤表现为便秘、便血、肛门部疼痛或不适等。免疫组化 :CDll7、CD34、Vim entin多为弥漫阳性 ,S- 10 0、HHF35多为阴性。经肛局部切除术 3例 ,经骶尾局部扩大切除术 1例 ,Hartmann术 3例 ,Mises术 3例 ,部分结肠切除 3例 ,活检 1例。结果 :术后复发 5例 ,3例为经肛局部切除 ,2例为姑息性 Hartmann术。 1、3、5年生存率分别为 91.7% (11/ 12 )、37.5 % (3/ 8)、2 8.6 % (2 / 7)。结论 :大肠间质瘤术前不易确诊 ,多发于直肠、肛管 ,完整的外科手术切除是最有效的治疗方法。

Objective:To study the diagnosis and treatment of large intestinal stromal tumors.Methods:13 cases of large intestinal stromal tumors were collected. Their clinical and pathological data were analyzed retrospectively. The group included 9 males and 4 females, 15.4% of large intestinal stromal tumors were situated in colon, 61.5% in rectum, and 23.1% in anal canal. The most common clinical presentations of colon stromal tumors were abdomen mass, abdominal pain or discomfort, large bowel obstruction, etc. The most common clinical presentations of rectum or anal canal stromal tumors were constipation, hematochezia, anus pain or discomfort, etc. Histologically, 1 cases classified as benign, 2 cases as potentially malignant, 10 cases as malignant. Immunohistochemical staining results: Vimentin, CDll7 and CD34 diffuse strong expression, positive rates were 88.9%(8/9), 100%(7/7), 87.5%(7/8), respectively. S-100, HHF35 negative expression mostly, positive rates were 11.1%(1/9), 20%(2/10), respectively. 3 patients were treated by trans-anal resection, 1 was treated by tans-sacral resection, 3 were treated by Hartmann's operation, 3 were treated by abdomino-perineal resection. Incision biopsy was performed on 1 case.Results:All the patients treated by trans-anal resection and 2 patients treated by palliative Hartmann's operation had local recurrence. The 1-, 3-, 5-year survival rates were 91.7% (11/12), 37.5% (3/8), 28.6% (2/7) .Conclusion:Preoperative diagnosis of large intestinal stromal tumors is difficult, most of them were situated in rectum and anal canal, extension resection is the most effective treatment measures.