胃肠道外间质瘤的治疗与预后

Clinical Treatment and Prognosis of External Gastrointestinal Stromal Tumor

目的探讨胃肠道外间质瘤(EGIST)的临床表现、外科治疗及预后。方法回顾性分析2004年1月-2010年6月收治的35例EGIST患者的临床资料。男26例,女9例;年龄33～78岁,平均56岁。病程5 d～8个月,平均2个月。临床表现主要有腹部不适、腹痛及腹部包块等。均在术前行CT或腹部增强CT等检查发现病灶,其中位于系膜16例,网膜15例,腹膜后4例。35例均行手术治疗。结果术后均由病理学检查及免疫组织化学检测确诊,肿瘤标本镜下均以梭形细胞为主;极低危险、低危险、中危险、高危险患者分别为0、3、0、32例。免疫组织化学检测示酪氨酸激酶受体(CD117)、DOG-1、骨髓干细胞抗原(CD34)、酸性钙结合蛋白、平滑肌肌动蛋白、结蛋白阳性率分别为91.4%(32/35)、100%(3/3)、71.4%(25/35)、8.6%(3/35)、22.9%(8/35)、0%(0/35)。15例患者均获随访,时间19～96个月,平均46个月。8例出现进展,7例病情稳定。结论 EGIST发现时往往体积较大,预后较差,手术切除是首选治疗手段,甲磺酸伊马替尼对其具有较好的治疗效果。

Objective To investigate the clinical manifestations,treatment and prognosis of patients with external gastrointestinal stromal tumor（EGIST）.Methods Clinical data of 35 patients with EGIST treated between January 2004 and June 2010 were retrospectively analyzed.There were 26 males and 9 females in our study with their age ranging from 33 to 78 years old,averaging at 56 years.The course of the disease ranged from 5 days to 8 months,averaging 2 months.The main clinical manifestations included abdominal discomfort,pain and abdominal mass.CT or Enhancement CT was the main diagnostic method,which showed that 16 cases of the disease had their focuses on the mesentery,15 on the omentum,and 4 on the retroperitonium.All 35 patients accepted surgical operations.Results After operation,the diagnosis was confirmed through pathological examination and immunohistochemistry.The tumors were mainly composed of spindle cells.The number of very low risk cases,low risk cases,moderate risk cases and high risk cases were respectively 0,3, 0 and 32.Immunohistochemistry showed the positive rates of tyrosine kinase receptors（CD117）,DOG-1,bone marrow stem cell Antigen（CD34）,acid calcium-binding protein（S-100）,smooth muscle actin（SMA）,and Desmin were 91.4%（32/35）,100%（3/3）,71.4%（25/35）,8.6%（3/35）,22.9%（8/35）,and 0%（0/35） retrospectively.The follow-up time ranged from 19 to 96 months averaging 46 months for 15 patients.During the follow-up period,8 patients improved their conditions,and 7 were stable.Conclusions EGIST is often in high-risk with giant mass when identified and the prognosis is not so good.Surgical operation is the main treatment method,and imatinib used as an adjuvant treatment can have a satisfying effect.