小肠间质瘤临床特点及诊断分析

Clinical features and diagnosis of small intestinal stromal tumor

目的通过分析小肠间质瘤(SIST)的临床特点,提高SIST的诊治水平。方法对我院2000年1月至2009年7月收治的SIST50例的临床表现、诊断方法、病理进行回顾分析。结果 50例SIST主要临床表现:贫血39例(78.0%),消化道出血30例(60.0%),腹痛22例(44.0%),腹块17例(34.0%)。各种诊断方法的阳性检出率:B超32.0%(16/50)、胃镜38.4%(10/26)、钡造影75.0%(9/12)、多层螺旋CT91.8%(22/24)、双气囊小肠镜(4/4)。病理:低度以下恶性程度11例(22%),中高度恶性39例(78%);免疫组化:CD117:阳性89.4%(42/47)、CD34:阳性63.8.%(30/47)。术前转移20.0%(10/50),术后发生转移7例。同时存在或再发其他肿瘤共5例。结论 SIST常见临床表现为贫血、消化道出血、腹痛、腹块;腹部螺旋CT结合消化内镜检查可提高早期诊断水平;SIST多为恶性,容易转移及合并其他肿瘤,需终身随访。

Objective The aims of this study were to analyze the clinical features of small intestine stromal tumor （SIST） and how to improve the diagnosis of SIST. Methods Data of 50 cases with comfirmed SIST in Guangdong General Hosptial from January 2000 to July 2009 were reviewed. A retrospective analysis was made on clinical manifestation, diagnostic methods, pathological characteristics and prognosis. Results The main clinical manifestations of SIST included anemia in 39 cases （78.0%）, gastrointestinal bleeding in 30 cases （60.0%）, abdominal pain in 22 cases （44.0%）, and abdominal mass in 17 patients （34.0%）. Positive rates of diagnostic method were 32.0% （16/50） by B ultrasound, 38.4% （10/26） by gastroscopy, 75.0% （9 / 12） by barium contrast, 91.8% （22/24） by CT, （4 / 4） by double-balloon enteroscopy , respectively. Pathologically, 11 cases of SISTs were low malignant （22%）, while 39 cases were moderate or high malignant （78%）. Based on Immunohistochemistry, CD117-positive was seen in 42 patinets （89.4%, 42/47）, CD34-positive was seen in 29 patients （63.8%, 30/47 ）. The metastasis rate before operation was 20.0% （10/50） . Five cases of SIST occurred another malignant tumor. Conclusion The most common clinical manifestations of SIST are anemia, gastrointestinal bleeding, abdominal pain, and abdominal mass. The combination of CT-scan and digestive endoscopy is helpful for early diagosis. Most of the SISTs are malignant. Because SIST has high rate of metastasis and can coexist with other tumors, so lifelong follow-up is needed.