腹腔间质瘤33例临床治疗体会

Clinical Treatment of 33 Patients with Stromal Tumor in Abdominal Cavity

【目的】探讨腹腔间质瘤的临床、病理特点及诊断、治疗和预后。【方法】回顾性分析2006年4月至2008年8月收治的33例腹腔间质瘤患者的临床和病理资料。【结果】手术切除率93．9％（31／33），17例行淋巴结清扫，1例见淋巴结转移。瘤体直径为1．5～25．0cm，良性11例，交界性4例，恶性18例。CD117（＋）93．8％，CD34（＋）76．4％，Vimentin（＋）65．3％，SMA（＋）45．8％，S-100（＋）19．7％，Nestin（＋）11．2％，CD117和CD34共同阳性率为56．2％。极低度危险性7例，低度危险性6例，中度危险性14例，高度危险性5例。术后随访率90．9％（30／33），随访6～28个月，12例良性或交界性间质瘤患者无复发和转移，13例恶性患者未进一步行任何治疗，5例高度危险性间质瘤均定期复查：1例坚持服用格列卫，未见复发或转移；1例发生肝转移行射频损毁术；3例发生不同程度的肿瘤局部复发伴腹腔转移，经再次手术治疗或（和）口服格列卫等治疗，均存活至今。【结论】腹腔间质瘤无特殊临床表现，术前内镜、B超和cT是主要的辅助检查及鉴别方法；手术切除是间质瘤首选的治疗手段，其预后与恶性潜能分级有关。具有分子靶向治疗的格列卫表现出良好的_疗效，可用于间质瘤的辅助治疗。

[Objective] To investigate the clinical characteristics, pathological features and the prognosis of stromal tumors in abdominal cavity. [Methods] Clinical and pathological data of 33 cases with abdominal stromal tumors from April 2006 to August 2008 were retrospectively analyzed. [Results] The overall resection rate was 93.9% （31/33）. Seventeen cases were treated with lymph node resection including 1 case with lymphocyte metastasis. The diameter of the tumor varied from 1.5 to 25.0 cm. Among all cases, 11 cases were benign, 4 were borderline and 18 were malignant. The positive rate of CDl17, CD34, Vimentin, SMA, S-100 and Nestin were 93.8%, 76.4%, 65.3%, 45.8%, 19.7% and 11.2%, respectively. CDl17 and CD34 were both positive in 56.2%. Pathologic analysis of 32 resected specimens showed 7 cases with very low risk, 6 with low risk, 14 with intermediate risk and 5 with high risk. The follow-up rate was 90.9%（30/33） in 6-28 months. None of 12 cases with benign or borderline stromal tumors had recurrence and metastasis. Thirteen cases with malignant tumors refused further treatment. Other 5 cases with high risk obtained regular reexami- nation, among which 1 patient insisted on taking Gleevec orally, with no recurrence or metastasis, 1 patient with liver metastasis after operation underwent therapy of radiofrequency, and 3 cases with local recurrence and abdominal metastasis were treated with reoperation or/and oral Gleevee. These 5 cases were alive till now. [Conclusion]The abdominal stromal tumors lack typical clinical manifestations. Through endoscopy, B-Ultrasound and CT, the stromal tumors can be initially diagnosed and identified with other tumors before operation. Surgical resection is the preferred treatment for stromal tumors. After resection, the recurrent and metastasis rate are correlated to Fletchers classification. In addition, the molecular targeted agent, Gleevec, recently has satisfied efficacy and can be used as an adjuvant therapy.