十二指肠间质瘤46例临床诊治分析

Duodenal gastrointestinal stromal tumors: diagnosis and treatment of 46 cases

目的:分析十二指肠间质瘤的临床特点、诊断方法和手术治疗方式,探讨患者各临床因素与术后生存期的关系。方法:回顾性分析中南大学湘雅医院11年间诊治的46例十二指肠间质瘤患者的临床资料。结果:患者以上消化道出血、腹部胀痛不适为主要症状。发病部位以降部多见。行局部切除(LE)22例,16例行节段性十二指肠切除术(SD),行胰十二指肠切除术(PD)6例,2例患者放弃治疗(1例死亡,1例失访)。术后随访44例,28例生存,6例死亡,10例失访。4例出现术后并发症,其中1例为LE术后并发十二指肠瘘,经非手术治疗痊愈出院,3例为PD术后胰瘘(1例死于术后胰瘘出血性休克,2例经非手术治疗痊愈出院)。患者术后平均生存期为(35.4±28.7)个月,术后生存期在性别、年龄、肿瘤大小、肿瘤复发风险分级、肿瘤发生部位及手术方式各组间差异无统计学意义(均P>0.05)。结论:CT、消化道内镜及超声内镜检查是术前诊断十二指肠间质瘤的主要手段,完整切除是该病基本手术方式,术后生存期在性别、年龄、肿瘤大小、肿瘤复发风险分级、肿瘤发生部位及手术方式等无关。

Objective： To investigate the clinical characteristics, diagnostic method and surgical procedures of duodenal gastrointestinal stromal tumors （DGISTs）, and the relations of postoperative survival with various clinical factors. Methods： The clinical data of 46 DGIST patients admitted in Xiangya Hospital over the past 11 years were retrospectively analyzed.Results： Among the DGIST patients, the major symptoms were upper alimentary tract hemorrhage and abdominal distending pain or discomfort, and the most commonly involved region was the descending part of the duodenum. Twenty-two patients received local tumor excision （LE）, 16 patients underwent segmental duodenectomy （SD）, 6 patients were subjected to pancreaticoduodenectomy （PD）, and two patients refused operative treatment （one died and one was lost to follow-up）. Forty-four patients were followed up after surgery, at which time, 28 cases had survived, 6 cases and died, and 10 cases were lost to follow-up. Postoperative complications occurred in 4 patients; one of them developed duodenal fistula after LE and recovered after conservative treatment, and three cases developed pancreatic fistula following PD, of whom, one died of hemorrhagic shock and the other two recovered after conservative treatment. The mean survival time was （35.4~28.7） months, and the differences in postoperative survival among the groups divided according to gender, age, tumor size, tumor recurrence risk classification, tumor location and surgical procedures showed no statistical significance （aU P〉0.0S）. Conclusion： C% endoscopy and ultrasound endoscopy are the main approaches for preoperative diagnosis of DGISTs. Complete resection is the primary treatment for this condition and the postoperative survival is not associated with gender, age, tumor size, tumor recurrence risk classification, tumor location or surgical procedures.