胃肠道间质瘤47例临床分析

Clinical analysis of 47 patients with gastrointestinal stromal tumors

目的探讨胃肠道间质瘤(GIST)的诊断、免疫组化特点、良恶性的判断和治疗。方法回顾性总结分析47例GIST的临床和病理资料。结果本组GIST位于胃30例,小肠13例,结肠3例,肛管1例;28例行胃镜检查,确诊4例,发现病灶21例,8例行超声胃镜并穿刺活检,6例确诊;CD117阳性率为82.97%(39/47),CD34阳性率为93.61%(44/47);病理诊断良性间质瘤13例,交界性7例,恶性27例。本组均行肿瘤局部切除或局部消化道部分切除,获得随访的11例良性间质瘤患者全部存活,24例恶性及6例交界性间质瘤患者1例复发,3例发生转移,8例死亡。结论超声内镜结合胃肠道影像学检查是临床诊断的主要方法,确诊需依靠组织病理学检查和免疫组化染色,手术局部切除是有效的治疗手段。

Objective To investigate the imaging and immunohistochemical features, differential diagnosis and the therapy of gastrointestinal stromal tumors （GIST）. Methods Clinical and pathological data of 47 cases with GISTs were analyzed retrospectively. Results Among 47 cases of GISTs, 30 cases orginated in the stomach, 13 cases in the small intestine, 3 cases in the colon and 1 case in the anal canal. Gastroscopy was performed in 28 cases, lesions were found in 21 cases and preoperative diagnosis was made only in 4 cases. EUS - guided fine needle aspiration （EUS - FNA） was performed in 8 cases, diagnosis was made in 6 cases. The positive rates of CD117 and CD34 were 82.97 % and 93.61% respectively. Pathology revealed 13 benign cases, 7 borderline and 27 malignant cases. All patients were treated by surgical local resection. 11 benign cases were alive on the latest follow- up. In 24 cases of malignance and 6 cases of borderline, 1 developed recurrence and 3 developed metastasis, 8 died. Conclusion EUS and image exminations play an important role in diagnosis, but their final diagnoses depend on pathological and immunohistochemical examination. Surgical local resection is the effective therapeutic procedure for GISTs.