胃肠间质瘤56例临床诊治分析

Diagnosis and Treatment of 56 Cases with Gastrointestinal Stromal Tumors

目的总结胃肠间质瘤(GIST)的临床病理特征,探讨外科治疗效果并评价不同部位GIST的预后。方法对川北医学院附属医院自2001年12月到2007年12月外科收治的56例GIST患者的临床病理资料进行回顾性分析并作随访。结果56例GIST术前无一例确诊。肿瘤发生部位:胃27例,小肠11例,其他部位18例。6例首诊已出现转移,其中5例为胃外GIST。10例呈明显浸润生长,其中9例为胃外GIST。免疫组织化学检测:CD117阳性率97.1%,CD34阳性率87.5%。术后随访时间5～75个月,总获访率71.4%(40/56),28例无瘤健在,5例带瘤生存,7例于术后2～20个月死亡。死亡病例主要为胃外GIST,且为首诊转移或明确浸润生长者。结论GIST术前确诊困难,CD117和CD34是病理确诊的重要标志物。肿瘤的大小及生长方式与肿瘤的发生部位相关。肿瘤的预后与其发生部位、生长方式及首诊转移有关。治疗仍以外科手术为主,但高度恶性的GIST单纯外科治疗预后差。

Objective To summarize the clinical and pathological characteristics and analyze the relationship between tumors′ location and their prognosis,and the efficacy of surgical management.Methods The clinical and pathological data of 56 cases with GISTs admitted to surgical department of hospital affiliated to North Sichuan Medical College from Dec.2001 to Dec.2007 were collected.Their pathological features,clinical manifestations and especially the surgical outcomes were analyzed retrospectively.Results None of the 56 cases＇preoperative diagnosis was definite.Of the 56 cases,27 cases occurred in stomach,11 in small intestine and 18 occurred in other sites.6 cases of first diagnosis were discovered to have metastasized,5 cases among them were tumors growing out of stomach.10 cases invaded the adjacent organs or tissues obviously and 9 of them were intestinal GISTs.The positive rates for CD117and CD34were 97.1%and 87.5%respectively.The follow-up was obtained successfully in 40 cases（71.4%）,and lasted 5-75 months.Of the 40 cases,28 were still alive without tumors,5 survived with tumors and 7 died within 2-20 months after surgical management.The 7 died cases were mainly derived from intestinal tract and invaded the adjacent organs or tissues obviously.Conclusion Definite preoperative diagnosis is hard to get.CD117and CD34are sensitive markers for the finally definite diagnosis by pathology.The tumor′s size and growth pattern are relevant to its occurrence location,and the occurrence location of tumors and its growth pattern,preoperative metastasis are relevant to the prognosis of GISTs.Surgical management is the effective choice of treatment for GISTs,however,the efficacy of surgical management with GIST of high malignant degree is poor.