十二指肠间质瘤39例临床分析

Gastrointestinal stromal tumors of the duodenum： a clinical analysis of 39 cases

目的 探讨十二指肠间质瘤的临床表现及外科治疗经验.方法 回顾性分析中国医科大学附属第一医院1992年1月至2010年12月收治的39例十二指肠间质瘤的临床资料.结果 本组十二指肠间质瘤的最常见症状为上消化道出血,占46％（18/39）.增强CT是有效的诊断方法,准确率为69％（22/32）,十二指肠镜检查的准确率为83％ （15/18）.发病部位以十二指肠降部多见,占69％（27/39）.39例均行手术治疗,R0切除34例,其中十二指肠部分切除术16例,胰十二指肠切除术12例,十二指肠节段切除术及胃大部切除术各3例,另有转流或探查手术5例.围手术期死亡1例,有9例出现术后并发症,均行非手术治疗治愈.R0切除术后患者1、3、5年生存率分别为90％、72％、41％.结论 腹部增强CT和十二指肠镜检查是诊断十二指肠间质瘤的有效方法.根据十二指肠间质瘤的大小和位置采取不同的手术方式以达到R0切除,而十二指肠部分切除术应该是首选术式.对于中、高危险度的患者,术后应给予伊马替尼辅助治疗.

Objective To investigate the clinical characteristics and surgical treatment of gastrointestinal stromal tumors （GIST） of the duodenum. Methods The clinical data of 39 patients with duodenal GISTs from 1992 to 2010 were analysed retrospectively. Results The most common symptoms of duodenal GISTs were alimentary tract hemorrhage, occuring in 18 cases of the 39 cases （46%）. Clinical diagnosis established by CT in 22 cases （69%）. Dnodenoscopy performed in 18 cases established the definite diagnosis of GIST in 15 （83%）. Duodenal GISTs were most commonly located in the descending portion of the duodenum in 27/39 cases （69%）. All 39 cases received surgical treatment, with R0 resection in 34 cases, including partial resection of the duodenum in 47% （16/34） , pancreaticodenectomy in 35% （12/34）, segmental resection of the duodenum in 3 cases, subtotal gastrectomy in 3 cases; One died perioperatively and postoperative complications developed in 9 cases, which were cured by conservative therapy. The 1,3,5 year survival rate was 90% , 72% , 41% for those receiving R0 resection. Conclusions The abdominal CT scan with contrast and duodenoseopy are helpful to establish the diagnosis of duodenal GISTs. Surgical procedures depend on the size and site of the lesion for R0 resection. To decrease postoperative recurrence and prolong survival adjuvant therapy with Imatinib is necessary.