胃肠道神经鞘瘤的诊断及治疗

Diagnosis and treatment of schwannoma of gastrointestinal tract.

目的 分析胃肠道神经鞘瘤的发病概况并探讨其诊治方法。方法 对１２ 例胃肠道神经鞘瘤进行回顾性分析并文献复习。结果 术前确诊仅１ 例，手术切除１０ 例，术中活检２ 例；良性５ 例，２ 年内死于伴发病２例，存活已＞ ２ 年３ 例；恶性４ 例，１ 年及３ 年内死亡各为３ 例及１ 例；恶变倾向３ 例，２ 年内死亡１ 例，已存活＞ ６年２ 例。结论 胃肠道神经鞘瘤术前诊断困难，确诊靠病理，免疫组化检查有助于与平滑肌瘤鉴别。良性者可行局部切除，恶性或恶性倾向者应行根治性切除，术中快速病理切片有助于决定手术方式。

Objective To analyse the incidence of schwannoma of gastrointestinal tract and investigate the ways of diagnosis and treatment.Methods Analysing retrospectively 12 cases of schwannoma of gastrointestinal tract and reviewing the published papers.Results Only one case was definitely diagnosed in preoperation.10 patients received tumor resection and 2 patients were just only done by intraoperative biopsy.In 5 benign cases,2 died from other diseases within 2 years and 3 lived for more than 2 years.In 4 malignant cases,3 and 1 died within one year and 3 years respectively.In 3 malignant-trend cases,1 died within 2 years and 2 lived for more than 6 years.Conclusion Preoperative diagnosis of schwannoma of gastrointestinal tract is difficult.Definite diagnosis depends on pathological examination.Immunohistochemistry examination is helpful for differentiation between schwannoma and leiomyoma.Benign tumor can be effectively treated by local excision but those of malignancy or malignant-trend should be treated by radical excision.Intraoperative frozen section will be good to determine what kind of operation should be taked.