十二指肠间质瘤30例外科治疗分析

Surgical Treatment of 30 Cases of Duodenal Gastrointestinal Stromal Tumors

目的:探讨十二指肠间质瘤的临床特征、外科治疗方法及效果。方法:回顾分析复旦大学附属中山医院1995—2006年间收治的30例十二指肠间质瘤患者的临床资料。结果:肿瘤最常见于十二指肠降部60%(18/30),其次为水平部20%(6/ 30),球部10%(3/30),升部10%(3/30)。肿瘤以恶性多见,占76.7%(23/30),交界性13.3(4/30),良性10%(3/30)。细胞类型以梭形细胞型多见,占73.3%(22/30),混合型次之,占23.3%(7/30),上皮细胞型少见,占3.3%(1/30)。临床表现无特异性,以黑便多见,占40%(12/30),其次为腹痛30%(10/30)、饱胀13.3%(7/30)、贫血20%(6/30)。诊断方法的选择依次为上消化道钡餐造影、胃镜、内镜超声及CT。30例患者均获得手术治疗,15例行胰十二指肠切除术,其中13例为降部肿瘤,2例为横部肿瘤,术后病理检查均无淋巴结转移;5例降部和2例球部肿瘤行肿瘤及十二指肠壁局部切除术,4例水平部和3例升部肿瘤行十二指肠节段切除术,另有1例球部肿瘤行远端胃大部切除术。术后随访15个月～9年,其中24例获得完整随访,1年生存率、3年生存率分别为100%和87.5%。结论:十二指肠间质瘤以恶性者多见,其局部侵袭性不如消化道癌,淋巴结转移少见,术前诊断主要依据上腹部增强CT、胃肠道钡剂造影、胃镜以及内镜超声检查,其手术方式的选择更多取决于肿瘤的部位和大小。

Objective： To investigate clinical characteristics and surgical effect of duodenal gastrointestinal stromal tumors （GISTs）. Methods：Clinical data of 30 duodenal GIST patients from 1995 to 2006 were analyzed retrospectively. Results：The lesions mainly located in the descending duodenum （60%）, unusually in the bulb（10 %）, the transverse portion （20 %） and ascending part （10%）. Pathological examination revealed 3 cases of benign tumor, 4 cases of borderline tumor and 23 cases of malignant tumor, and microscopically, the tumors were composed of spindle cells （22 cases）, or epithelial cell （1 cases）, or both of two cell types （7cases）. The clinical manifestations are non-specific, mostly were melena （40%）, as well as abdominal pain （30%）, fullness （23.3%）, arid anemia （20%）. We performed the diagnosis by upper gastrointestinal radiography, gastroscopy, endoscopic ultrasonography and CT scan. All the 30 patients received surgical resection, of which 15 with pancreaticoduodenectomy, 7 with local resection, 7 with segmental resection of duodenum, and 1 with distal subtotal gastrectomy. The 1 and 3-year survival rates were 100 %and 87.5 %, respectively. Conclusion：Most duodenal GISTs are malignant, surgical program is mainly determined by the location and size of the tumor.