胃肠间质瘤28例诊治分析

Analysis of diagnosis and treatment of gastrointestinal stromal tumors in 28 cases

目的探讨胃肠间质瘤(GIST)的临床诊断、治疗和预后。方法回顾性分析南开医院2002年1月至2007年9月收治的胃肠间质瘤28例临床资料及其肿瘤组织病理切片免疫组化结果。结果肿瘤部位以胃肠为主,本组均行手术治疗。术后病理诊断10例良性,18例为潜在恶性和恶性;免疫组化CD34阳性19例(67.9%),CD117阳性28例(100%),抗平滑肌抗体(SMA)阳性13例(46.4%),而S-100阳性1例(3.6%)。胃间质瘤中CD34表达率在良性肿瘤与恶性肿瘤之间以及交界性肿瘤与恶性肿瘤之间表达差异有显著性意义(P<0.05)。术后随访:良性GIST10例,平均随访时间25.6个月,8例无局部复发、转移;2例术后1年内复发再手术;恶性GIST18例,平均随访18.5个月,9例局部复发再手术,5例肝肺转移,4例死亡。结论CD34可能在胃间质瘤的发生、发展过程中发挥了重要作用。手术完全切除对于GIST是主要的治疗方法。肿瘤大小及核分裂像数目是GIST重要的预后因素。

Objective To study the diagnosis and treatment of gastrointestinal stromal tumors （GIST）. Methods The clinical data of 28 patients with GIST admitted into surgical department from January 2003 to September 2008 were retrospectively analyzed. Results The resection of gastrointestinal stromal tumors was undertaken in 28 cases. Stomach and small-bowel were often affected by this tumor. The tumors were benign in 10 cases and malignant in 18 cases. The expression of CD34 and CD117 had been seen in 19 cases （67. 9% ） and 28 cases （ 100% ） respectively with immunohistochemical staining. But the expression of SMA and S-100 in all eases were 13 cases （46.4%） and 1 case （3.6%）. There was a significant difference of CD34 expression both between benign tumor and malignant tumor, borderline tumors and gastric tumors （ P 〈 0.05 ）. Benign GIST in 10 cases were followed up for average 25.6 months ,8 of them had no local recurrence and metastasis, 2 cases of them relapsed and operated again. Malignant GIST in 18 eases were followed up for average 18.5 months,9 of them with local recurrence were treated with re-operation, 5 case of them had liver and lung metastasis, and 4 cases died. Conclusion CD34 might play roles in the process of carcinogenesis of gastric tumors. Gastrointestinal stromal tumors should be treated by total resection. The size of tumor and mitoses are the important prognosis factors for gastrointestinal stromal tumors.