35例小肠间质瘤诊治分析

Diagnosis and Treatment of Small Intestinal Stromal Tumor: An Analysis of 35 Cases

背景:小肠间质瘤的发病率低,临床症状不典型且缺乏简便有效的检查方法,术前确诊较为困难。目的:了解小肠间质瘤的临床表现,探讨如何提高小肠间质瘤的术前诊断率和合理的手术方式,以提高其诊治水平。方法:回顾性分析1993年4月～2004年6月仁济医院收治的35例小肠间质瘤的临床表现、诊治经过、病理学特点和预后,所有病例均经手术和病理证实。结果:脐周隐痛、消化道出血、贫血、腹部肿块和小肠梗阻是本组小肠间质瘤最常见的临床表现。小肠间质瘤多好发于十二指肠和空肠;80.0%的良性小肠间质瘤瘤体直径<5cm,93.3%的恶性小肠间质瘤瘤体直径>5cm;小肠间质瘤以肠腔外生长为主,良、恶性间质瘤在生长方式上无显著差异。空肠、回肠间质瘤的术前诊断率显著低于十二指肠间质瘤(P<0.01)。胃镜、增强螺旋CT和数字减影血管造影(DSA)对小肠间质瘤检出率较高。30例恶性间质瘤中20例(66.7%)行小肠肿瘤根治术,8例(26.7%)行小肠肿瘤减瘤荷手术,2例(6.7%)行姑息性手术。30例恶性间质瘤切除标本中9例有局部淋巴结转移,5例出现远处转移。结论:合理应用辅助检查方法可提高小肠间质瘤的术前确诊率,术中对间质瘤的良、恶性判断有困难者应行根治性切除术。

Background: The incidence rate of small intestinal stromal tumor is low and its clinical symptoms are atypical, furthermore, it lacks of simple and effective way for accurate and preoperative diagnosis. Aims: To understand the essential clinical manifestations of small intestinal stromal tumor and to appraise how to promote its preoperative diagnotic rate and eligible mode of operation. Methods: From April 1993 to June 2004, 35 patients were diagnosis as small intestinal stromal tumor in Renji Hospital. A retrospective analysis was made on clinical features, pathological characteristics, diagnosis, treatment and prognosis. All cases were confirmed by pathology. Results: The main clinical manifestations of small intestinal stromal tumor were vague pain over the umbilical region, gastrointestinal bleeding, anemia, abdominal mass and small bowel obstruction. The small intestinal stromal tumor had predilection in the duodenum and jejunum. The diameter of benign ones were smaller than 5 cm in 80.0% of patients, whereas that of malignant ones was >5 cm in 93.3% of patients. Most of them grew extraintestinally. No-significant difference was seen in the growth pattern of benign and malignant tumors. The preoperative diagnosis rates of jejunal and ileal stromal tumors were significantly lower than that of duodenal stromal tumors(P<0.01). The detection rates by fiberoptic endoscopy, enhanced spiral CT and digital subtraction angiography (DSA) were much higher. Among the 30 malignant cases, twenty(66.7%) underwent radical operation, eight (26.7%) had tumor cytoreduction, and the rest (6.7%) had palliative surgery. In the resected specimens, 9 cases showed regional lymph node metastases and 5 had distant metastases. Conclusions: The preoperative diagnosis rate can be improved by rational auxiliary examinations. In case of difficult judgment of benign or malignant stromal tumors during the operation, radical operation should be performed.