胃肠道间质瘤急症九例报告

Emergency complications of gastrointestinal stromal tumor:report of 9 cases

目的探讨胃肠道间质瘤(GIST)急症的临床、影像和病理特点。方法回顾性分析2005年2月至2011年2月收治的胃肠道间质瘤急症病例。结果经病理证实的GIST急症患者9例,其中消化道大出血2例,肠套叠4例,自发破裂并继发出血、感染、穿孔3例。胃底2例(均为消化道大出血),小肠7例(肠套叠4例,破裂3例)。CT显示2例腔内圆形肿块(胃间质瘤),显示靶征4例(肠套叠),其中回回套叠2例,回结套叠2例,破裂肿瘤则有各异的表现。实施近端胃切除术1例,胃壁楔形切除术1例,小肠部分切除术5例,右半结肠切除术2例。免疫组织化学显示CD117阳性8例,CD34阳性6例。结论胃肠道间质瘤可表现为急症,尽管罕见,但给予足够重视以获得早期诊断和外科干预。

Objective To explore the clinical,imaging and pathological characteristics of gastrointestinal stromal tumors（GIST）.Methods Nine patients with GIST with emergency complications treated from February 2005 to February 2011 were reviewed at the Affiliated Hospital of Qingdao University Medical College.Results Two patients experienced acute massive gastrointestinal bleeding,4 patients suffered from intussusceptions,and 3 patients had spontaneous tumor rupture and secondary hemoperitoneum,infection or perforation.Tumors were located in the bottom of the stomach in 2 patients and those in the small bowel in 7 patients.CT scan showed an intra-luminal round mass in 2 patients with stomach lesions,presented as a ＂target sign＂ in 4 patients with intussusception,and there were different findings in 3 patients with ruptured tumors.Of all the patients who had undergone surgery,one received proximal partial gastrectomy,one underwent wedge resection of the stomach,5 had partial small bowel resection,and 2 had right hemicolectomy.Eight of 9 patients were positive for CD117 immunohistochemically,and 6 patients were positive for CD34.Conclusions GISTs may present with emergency conditions,which are uncommon or even rare,but attention should be paid to early diagnosis and surgical intervention.