结直肠间质瘤49例诊治分析

The diagnosis and treatment of colorectal gastrointestinal stromai tumors

目的探讨结直肠间质瘤的临床病理特点及治疗手段。方法回顾性分析浙江大学医学院附属第一医院收治的结直肠间质瘤49例的临床病理及随访资料。计量资料采用单因素方差分析（ANOVA）；计数资料分析采用X2分析或Fisher确切概率法；应用生存分析评估患者的预后情况。结果患者中位年龄54岁，男女发病率无差异（49％比51％）。结直肠间质瘤起病隐匿，且临床症状无特异性，常见首发症状为排便习惯和大便性状改变、腹部不适和便血等。病理学检查：光镜下多为梭形细胞，呈束状或编织状排列，免疫组化染色显示CDll7和CD34高阳性表达。随访结果显示，高危险度患者行病灶局部切除后复发率明显偏高（P=0．018），无瘤生存时间明显较短（P=0．011）。结论免疫组化染色是鉴别结直肠间质瘤的可靠方法。极低和低危险度患者首选局部切除术，中、高危险度患者建议行根治性切除，并辅助伊马替尼治疗等综合治疗手段。

Objective To assess the clinicopathological features, treatment and prognosis of colorectal gastrointestinal stromal tumors （GISTs）. Methods Clinical data of 49 patients diagnosed as colorectal GISTs between December 2000 and September 2009 were reviewed. The major clinicopathological features, treatment modalities and outcomes were retrospectively analyzed. Analysis of variarance （ANOVA） was applied to measurement data, while X2 or Fisher＇s exact test was assigned to enumeration data. The survival analysis was applied to estimate the prognosis of 49 patients undergoing operative treatment. Results The median age of the patients was 54 years old. There was no significant sexual deference in the incidence （49% vs. 51% ）. The onset of colorectal GISTs was insidious and the clinical symptoms were nonspecific. Main complain involved changes of defecation habit and fecal property, abdominal discomfort and bloody stool. Pathological signs of colorectal GISTs under microscope are spindle cells in beam form or knitting shape, and immunohistochemical characteristics shows the highly positive expression rates of CD117 and CD34. The recurrence rate in high risk patients after complete tumor resection is significantly higher than that in low risk （ P = O. 018 ） , and the tumor-free survival time is also respectively shorter （ P = 0. 011 ）. Conclusions Clinical symptoms don＇t contribute much to the diagnosis of colorectal GISTs, while immunohistochemical staining is reliable in the identification of colorectal GISTs. Patients classified into very low and low risk groups can be cured with local excisions, while those in moderate or high risk group are recommended for radical excisions. The combination of complete resection and imatinib is recommended for a better prognosis.