小肠间质瘤小肠镜诊断及治疗32例分析

Clinical analysis of double balloon enteroscopy combined with surgical procedures in the diagnosis and treatment of 32 patients with small bowel stromal tumors

目的评价小肠间质瘤（SBST）双气囊小肠镜（DBE）诊断及外科治疗。方法回顾性分析经DBE检查并行外科手术治疗的32例SBST患者临床资料。21例患者于腹腔镜下手术，11例剖腹手术。结果DBE诊断SBST敏感性为84．2％。62．5％SBST位于空肠，37．5％位于回肠。肿瘤向腔内生长占56．3％，同时向腔内、外生长占31．3％，向腔外生长占12．5％。肿瘤细胞多为梭形细胞。肿瘤组织CD117、CD34、SMA、S-100阳性率分别为96．9％、68．8％、34．4％、25％；极低、低、中、高度风险分别为9．4％、37．5％、40．6％、12．5％。术后随访6个月至3年，4例复发，2例死亡。结论DBE对SBST的检出率高、定位准确，选择合适的手术方式切除肿瘤能改善预后。

Objective To evaluate the value of double balloon enteroscope （DBE）combined with surgical procedures in the diagnosis and treatment of small bowel stromal tumors （SBST）. Methods The clinical data of 32 cases with SBST undergoing DBE and surgical procedures in the diagnosis and treatment were retrospectively analyzed, including 21 cases of laparoscopy and 11 cases of open surgery. Results The sensitivity of DBE in diagnosing SBST was 84.2%. Up to 62.5% of SBST were detected in jejunum and 37.5% in ileum. Up to 56.3% of the tumors grew intraluminally,31.3% grew both intraluminally and extraluminally, and 12.5% grew extraluminally. Spindle cell was the predominant cell type of the tumors. Up to 96.9% of the cases showed immunopositivity for CDl17,68.8% for CD34,34.4% for SMA and 25% for S-100. Up to 9.4% of cases were at very low risk,37.5% at low risk,40.6% at intermediate risk and 12.5% at high risk. All cases were followed up from 6 months to 3 years. There were 4 cases of recur- rence, and 2 cases died of local recurrence and metastasis. Conclusion DBE has a high detection rate of SBST with accurate localization, and appropriate surgical procedures can improve the prognosis.