小肠间质瘤74例临床诊断分析

The analysis of clinical diagnosis for small intestinal stromal tumor： A review of 74 cases

目的 总结小肠间质瘤（SIST）的临床特征,评价多种影像、内镜诊断方法 对SIST的诊断价值.方法 收集2004年7月至2009年6月经手术或内镜病理确诊的SIST患者74例,回顾性分析患者的临床资料、影像学（小肠造影、腹部B超、螺旋CT）和双气囊小肠镜等检查结果 .将SIST按其生物学行为分为极低度、低度、中度及高度危险性4级,并对SIST的病理特点及与螺旋CT表现间的关系进行分析.结果 SIST发病部位最常见于空肠,共43例（58.1%）,其次是十二指肠17例（23%）,回肠10例（13.5%）.94.6%（70/74）的患者有临床症状,最常见的为消化道出血,共46例（67.2%）,腹痛23例（31.1%）.各种影像及内镜检查中螺旋CT诊断率和诊断符合率最高,分别为100%和72.1%.74例SIST病灶中,极低度危险性14例（18.9%）、低度危险性21例（28.4%）、中度危险性15例（20.3%）、高度危险性24例（32.4%）.螺旋CT检查有助于判断SIST的危险性.结论 SIST起病隐匿,早期诊断困难.螺旋CT检查无创、方便、可靠,并有助于对肿瘤的危险度及预后进行预测,可作为目前SIST首选的检查手段.

Objective To summarize the clinical characteristics of small intestinal stromal tumors（SIST）, and evaluate the diagnostic values of various imaging or endoscope examinations for SIST. Methods From July 2004 to June 2009, 74 patients whose operation or endoscopy biopsy tissues pathologically confirmed SIST were collected. The clinical data, imageology including enteroclysis, abdominal ultrasound, spiral computered tomography （CT） and the double-balloon enteroscopy report of the patients were analyzed retrospectively. According to biological behavior, the SIST was divided into four risk degree such as extremely low risk, low risk, moderate risk and high risk. The correlation between pathologic characters and spiral CT feature was analyzed. Results The most predilection site of SIST was jejunum in 43 patients （58.1 %）; secondarily duodenum in 17 cases （23%）; and 10 cases （13.5%） in ileum. About 94.6 percent of patients （70/74） showed clinical signs, the most common symptom was gastrointestinal bleeding in 46 cases （67. 2 % ）, abdominal pain in 23 cases （31.1%）. Of various photogrammetry examinations and endoscopy, spiral CT has the highest diagnosis rate and diagnosis coincidence rate, which was 100% and 72. 1% respectively. Among the 74 SIST lesions, 14 cases were extremely low biological risk （18. 9 % ）, 21 at low risk （28.4 % ）, 15 at moderate risk （20. 3%） and 24 at high risk （32.4%）. Spiral CT is helpful for the SIST risk diagnosis. Conclusions The onset of SIST was concealed and early diagnosis was very difficult. Spinal CT which could help to predict the tumor＇s risk degree and prognosis was noninvasive, convenient and reliable. Therefore, it could be the first choice for SIST examination at present.