胃肠道间质瘤31例临床诊治分析

Gastrointestinal stromal tumors: a clinical diagnosis and treatment analysis of 31 cases

目的:探讨胃肠道间质瘤(GIST)的临床特点、治疗方法,以提高诊断和治疗效果。方法:回顾分析2001年12月—2009年12月31例胃肠道间质瘤患者的临床诊断、治疗、病理资料及随访。结果:GIST好发于胃和小肠,临床表现缺少特异性,16例(51.6%)GIST发生于胃,8例(25.8%)发生于小肠,3例(9.7%)发生于结直肠(其中2例伴有肝转移),发生于肠系膜、网膜及腹膜后4例(12.9%)。CT检查呈现不规则软组织肿块,大部分边界完整。GIST表达CD117阳性者28例(90.3%),CT34阳性者22例(71.0%)。18例恶性GIST中9例接受甲磺酸伊马替尼治疗,术后3年存活5例,9例未接受甲磺酸伊马替尼治疗者1例失访,术后3年存活0例。结论:在区别GIST与平滑肌瘤或神经源性肿瘤时,CD117、CD34具有重要价值。CT、内镜超声检查是目前诊断GIST常用和重要的手段,手术切除是首选的治疗方法,甲磺酸伊马替尼辅助治疗能够提高患者的生存期。

Objective： To study the clinical features and treatment of gastrointestinal stromal tumors to improve diagnosis and cure rates.Methods： Retrospective analyzed the clinical diagnosis,treatment and pathological data of 31 cases with GIST from 2001 to 2009.Results： GIST occurs in the stomach and small intestine,the lack of specific clinical manifestations,16 cases（51.6%） GIST occurred in the stomach,8 cases（25.8%） occurred in the small intestine,3 cases（9.7%） occurred in colorectal,2 cases with liver metastasis,Occurred in the mesentery,omentum and peritoneum in 4 patients（12.9%）.CT revealed an irregular soft tissue mass,most of the border integrity.Expression of CD117-positive GIST in 28 cases（90.3%）,CT34 positive in 22 cases（71.0%）.Conclusion： Distinguish GIST and smooth muscle tumors or neurogenic tumors,CD117 and CD34 expression of specificity,has significant value.CT and endoscopic ultrasonography examination is the diagnosis of GIST commonly used and important means.Surgical resection is the more effective treatment.Imatinib mesylate in adjuvant therapy can improve the relapse-free survival rate of patients.