胃肠道间质瘤78例临床分析

Clinical Analysis of 78 Cases of Gastrointestinal Stromal Tumor

背景：胃肠道间质瘤（GIST）是一种胃肠道间叶源性肿瘤，近10年随着组织病理学、免疫组化和电子显微镜技术的不断发展，GIST的诊治取得了许多新的突破。目的：研究GIST的临床表现、诊断、治疗和预后。方法：回顾性分析2000年1月-2008年10月中国医科大学附属盛京医院收治的78例经病理检查确诊的GIST患者的临床资料。结果：GIST主要发生于胃和小肠，主要临床表现为腹胀、腹痛和消化道出血。细胞形态以梭形细胞和上皮样细胞为主。免疫组化CD117阳性率为84．6％，CD34阳性率为78．2％。68例患者行根治性手术治疗，21例复发；其余10例晚期患者接受手术和甲磺酸伊马替尼治疗，甲磺酸伊马替尼的临床获益率75％。结论：GIST的临床表现无特异性，CD117对其诊断较为重要，目前手术切除是GIST的首选治疗，分子靶向治疗将成为今后治疗的重要手段和发展方向。

Background： Gastrointestinal stromal tumor （GIST） is a gastrointestinal mesenchymal tumor. Because of the continuous development of histopathology, immunohistoehemistry and electron microscopy in recent 10 years, many new breakthroughs in the diagnosis and treatment of GIST have been obtain. Aims： To study the clinical manifestations, diagnosis, treatment and prognosis of GIST. Methods： The clinical data of 78 patients with pathologically proven GIST admitted from January 2000 to October 2008 at Shengjing Hospital of China Medical University were analyzed retrospectively. Results： Most GIST occurred in the stomach and intestine. The major manifestations were abdominal distension, abdominal pain and gastrointestinal bleeding. The predominant cell morphology was fusiform cells and epithelioid cells. Immunohistochemically, the positivity rates of CD117 and CD34 were 84.6% and 78.2%, respectively. Sixty-eight patients underwent radical surgery, 21 of them relapsed. The other 10 advanced GIST patients received surgery and imatinib mesylate therapy, and the clinical benefit rate of imatinib mesylate was 75%. Conclusions： The clinical manifestations of GIST are nonspecific. CD117 is very important for its diagnosis. At present, operation is the first choice treatment of GIST, and molecular target therapy may be the important measure and direction of therapy in the future.