双气囊电子内镜对小肠间质瘤的诊断价值

The value of double balloon endoscopy in diagnosis of patients with small intestinal stromal tumor

目的:评价双气囊电子内镜(DBE)在诊断小肠间质瘤中的价值,并比较DBE结果与多层螺旋CT小肠造影法(MSCTE)。方法:对2003年7月至2007年1月收治的62例经DBE检查确诊为小肠间质瘤患者的临床及病理资料进行回顾分析。结果:小肠间质瘤患者的主要临床表现为消化道出血、腹痛、腹部肿块和不完全小肠梗阻。62例小肠间质瘤患者中,原发于十二指肠者6例,空肠34例,回肠22例;发生远处转移者4例。58例局限性小肠间质瘤中,极低度危险者1例,低度危险者49例,中度危险者3例,高度危险者5例。62例患者经DBE检查诊断为小肠间质瘤57例,诊断率达91.9%;23例行多层螺旋CT小肠造影法(MSCTE)检查,诊断为小肠间质瘤20例,诊断率达87.0%。58例局限性病变患者手术完全切除后平均随访18个月,有2例患者复发,其中1例死亡。结论:DBE和MSCTE对小肠间质瘤均有较高的诊断率,两者结合有助于小肠间质瘤的早期诊断。

Objective To study the value of double balloon enteroscopy （DBE） in the diagnosis of small intestinal stromal tumor and to compare the diagnostic yield of DBE with multi-slice spiral CT enteroclysis （MSCTE）. Methods Clinical and pathological data of 62 patients with small intestinal stromal tumor admitted from Jul. 2003 to Jan. 2007 were retrospectively reviewed. Results The most commonly seen presenting symptoms were hemorrhage, pain, abdominal mass, and intestinal obstruction. There were 6 cases originating from the duodenum, 34 from the jejunum and 22 from the ileum. Disease was localized in 58 patients, and distant metastases occurred in 4 patients. Fifty-eight patients with localized disease were classified into： 1 case of very low risk, 49 of low risk, 3 of intermediate risk, and 5 of high risk. The lesions were detected in 57 of 62 patients by DBE, the diagnostic yield of DBE was 91.9%. The diagnostic yield of MSCTE was 87.0% （20/23）. Fifty-eight patients with localized disease were followed for an average of 18 months after radical operation, 2 patients showed recurrence and 1 patient died of the disease. Conclusions DBE has a high diagnostic yield in small intestinal stromal tumor and can be regarded as a standard diagnostic modality. MSCTE is a very useful and reliable method for diagnosing small intestinal stromal tumor. Small intestinal stromal tumor may be detected in its early stage with the combination DBE and MSCTE.