小肠间质瘤32例的临床特征及诊治

Clinical feature,diagnosis and treatment of small intestine stromal tumors in 32 cases

目的探讨小肠间质瘤(SISTs)的临床表现、影像学特点、治疗措施和预后。方法对2003年3月至2010年12月收治的32例SISTs的患者临床资料进行回顾性分析。结果 SISTs常见的临床表现无特异性,大多为:腹痛、腹部包块、肠梗阻、胃肠道出血及体重下降;但血清肿瘤学指标如癌胚抗原(CEA)、癌抗原199(CA199)等无明显异常。术前18例行消化道气钡双对比造影检查,10例检出病变,均未提示间质瘤可能。32例行CT检查,全部检出小肠病变或肿瘤,定性诊断准确21例;32例患者均行手术治疗,无围手术期死亡。术后病理结果为SISTs,其中良性间质瘤7例,潜在恶性11例,恶性14例。结论 SISTs无特异性临床症状,消化道气钡双对比造影诊断率低,CT检查具有一定的特征,两种检查互相配合,结合临床具有较高的定位定性诊断价值。CD117及CD34有助于诊断SISTs。早期诊断对改善SISTs的预后十分重要,积极手术切除和甲磺酸伊马替尼辅助治疗可以获得良好效果。

Objective To analyze the clinical manifestation,imageology characteristics,treatment and prognosis of small intestine stromal tumors（SISTs）.Methods The clinical data of 32 SISTs patients treated in our hospital from March 2003 to December 2010 were analyzed retrospectively.Results The common clinical manifestations of SISTs were abdominal pain,abdominal lump,intestinal obstruction,gastrointestinal hemorrhage and weight loss.The levels of serum tumor markers CEA and CA199 were in normal range.Eighteen patients underwent gastrointestinal air-barium double contrast radiography before operation,positive results were found in 10 cases,but no case was considered to be SISTs.All of the 32 patients underwent CT examination,and positive results were found in all patients.The exact diagnosis was established in 21 patients.All patients received surgical operation and no death occurred during perioperative period.Pathology diagnosis of all patients were SISTs,and 7 cases were benign stromal tumor,11 cases were potential malignant,14 cases were malignant.Conclusion There is no special clinical manifestation for SISTs.Air-barium double contrast gastrointestinal tract examination is not very sensitive for SISTs but CT plays more effective roles in the diagnosing.Combination of these 2 methods and the clinical manifestation presents more diagnostic value.CD117 and CD34 are the targets for diagnosis SISTs.Early diagnosis is very important to improve prognosis of SISTs.Operation assisted by imatinib mesylate therapy is effective treatment for SISTs.