胃肠道间质瘤的诊断和治疗

The diagnosis and treatment of gastrointestinal stromal tumors

目的探讨胃肠道间质瘤(GISTs)的诊断和治疗。方法对我院1999年1月～2004年3月外科治疗的GISTs病例进行回顾性分析。结果收集GISTs病例40例,其中手术切除38例,无法切除2例。按照Fletcher原则分类,极低恶性6例,低度恶性7例,中度恶性11例,高度恶性16例。CD117和CD34阳性为80%、85%。31例得到随访(29例切除,2例未切除)。在29例切除中,5例发生复发和转移,复发时间为术后6至30个月(平均16.6个月),未能手术切除的平均存活时间为9个月。2例进行了伊马替尼治疗,1例部分缓解,1例稳定。结论(1)GISTs好发于中年人,以黑便、腹部肿块为主要症状。GISTs可发生于腹腔内任何部位,好发于胃和小肠。(2)免疫组化的检测是诊断GISTs所必须的。(3)Fletcher的恶性潜能分类符合临床治疗和预后的需要。

Objective To evaluate the clinical diagnosis and treatment of gastrointestinal stromal tumors（GISTs）. Methods The clinical data of patients with GISTs admitted into surgical department from Jan 1999 to Mar 2004 were retrospectively analyzed. Results There were 40 cases enrolled, with a male to female ratio of 30： 10, Thirty -eight patients underwent complete tumor resection, two did laparotomy only, According to the Fletcher classification, six patients were of very low risk, seven of low risk, eleven of intermediate risk, and sixteen of high risk. CD119 staining was positive in 80% cases, and CD34 was in 85%, Thirty-one patients were followed up, with 5 out of 29 postoperative patients suffering from recurrence and metastasis 6 to 30 months postoperatively. Two patients with unresectable tumor survived an average of 9 months. Gleevec was administered to two patients with partial relief achieved in one. Conclusion 1. GISTs are predominantly found in the middle-aged. Stomach and small bowel are most often affected. 2. Immunohistochemical staining was necessary for the diagnosis of GISTs. 3. Fletcher classification is useful guide for clinical treatment and prognosis prediction.