十二指肠胃肠间质瘤22例诊治分析

Diagnosis and treatment for gastrointestinal stromal tumors of the duodenum： a report of 22 cases

目的探讨十二指肠胃肠间质瘤的临床特征、诊断与治疗。方法回顾分析2005年1月至2010年9月诊治的22例十二指肠胃肠间质瘤患者的临床病例资料。本组患者均行手术切除治疗，包括肿瘤局部切除12例，其中1例合并远端胃大部切除及右肾切除；十二指肠节段切除6例；胰十二指肠切除术4例，其中1例合并右半结肠切除。结果危险度分级为极低危组4例，低危组5例，中危组8例，高危组5例。CD117阳性率95．5％（21／22），CD34阳性率86．4％（19／22），SMA阳性率54．5％（12／22），S-100阳性率9．1％（2／22）。术后随访10—66个月，平均随访30．9个月，其中20例获得完整随访，2例死于肿瘤复发或转移，余均无瘤生存。结论内镜超声和CT是术前诊断十二指肠胃肠间质瘤的有效方法，确诊需依靠病理及免疫组化。外科手术仍是当前十二指肠胃肠间质瘤最主要的治疗方法，需依据肿瘤的大小及部位采取不同的手术方式。高危患者术后联合靶向治疗可改善预后。

Objective To explore the clinical characteristics,diagnosis and treatment of duodenal gastrointestinal stromal tumors. Methods The clinical data of 22 patients with gastrointestinal stromal tumors of the duodenum from January 2005 to September 2010 were analyzed retrospectively. Gastrointestinal stromal tumors of the duodenum were mainly located in the descending portion（50% ）and the transverse portion（22.7% ）, the common presenting symptoms included melena and abdominal pain. All the patients received completely surgical resection, including local resection in 11 cases, segmental resection in 6 cases and pancreatoduodenectomy in 4 cases. Results Four patients in very low risk group ,5 in low risk group,8 in intermediate risk group and 5 in high risk group. Immunohistochemistry demonstrated that CD117 was positive in 21 cases（95.5% ） ,CD34 positive in 19 cases（86.4% ） ,SMA positive in 12 cases （54.5%） and S - 100 positive only in 2 cases （ 9. 1% ）. The mean follow - up length was 30.9 （ range, 10 - 66） months ,20 patients got follow - up and 2 cases died of recurrence and metastasis, the others were tumor - free survived. Conclusion Endoscopic ultrasonography and CT are effective diagnostic methods. The diagnosis for gastrointestinal stromal tumors of the duodenum depends on pathological observation and immunohistochemical examinations. At present surgery is still the main treatment, both size and location will influence the choice of surgical procedure for gastrointestinal stromal tumors of the duodenum. Targeted therapy can improve the prognosis of the high risk patients.