胃肠道间质瘤的诊疗体会——附21例报告

Diagnosis and treatment of gastrointestinal stromal tumor：A report of 21 cases

目的 探讨胃肠道间质瘤的诊断和治疗.方法 对2000年6月至2012年6月收治的21例胃肠道间质瘤患者的临床特点进行回顾性分析.21例均经手术治疗并经病理证实,其中男性12例,女性9例;发病年龄23～75岁,中位年龄55.6岁.术中行淋巴结清扫5例,术后5例患者服用甲磺酸伊马替尼,服药时间6~40个月,剂量为400 mg/d.结果 本组GIST病变部位：胃9例,十二指肠1例,小肠7例,结肠2例,直肠2例.21例均在术前通过影像学检查明确病灶部位.术后均由病理学检查及免疫组织化学检测确诊.酪氨酸激酶受体（CD117）阳性率为95.24% （20/21）,骨髓干细胞抗原（CD34）阳性率76.19%（16/21）.有效随访17例,随访12个月至10年.3例于术后6～24个月肿瘤恶化死亡,其中有1例服用甲磺酸伊马替尼8个月后死亡;7例肿瘤复发,其中3例出现远处转移,4例再次接受手术治疗;7例病情稳定,其中4例服用甲磺酸伊马替尼.结论 提高对GIST的认识,减少误诊,积极的手术切除结合靶向治疗是改善其预后的主要措施.

Objective To discuss the diagnosis and treatment of gastrointestinal stromal tumor. Methods Clinical data of 21 patients with gastrointestinal stromal tumor who were admitted between June 2000 and June 2012 were analyzed retrospectively. Results 9 of all lesions located in stomach, 7 was in intestine, 2 were in colon, 2 were in rectum and 1 was in duodenum. All patients＂ focus locus were identified by imaging examination. All lesions in them were confirmed using imaging examina- tions before operating, and after operations, they were further confirmed according to the result of pa thology or immunohistochemistry. The positive rate of CDl17 was 95.24~ （20/2l） and that of CD34 was 76. 19~/4 （16/21）, 17 patients were followed up postoperatively ranging from 12 months to 10 years. During the follow-up period, 3 cases died in 6 to 24 months after operating due to tumor pro- gression, in which 1 case died after management of imatinib mesylate. 7 cases present tumor occur- rence and 3 of them showed tumor metastases. 4 cases undertook second operation for treatment. 7 ca- ses were surviving well, 4 of them was managed with imatinib mesylate. Conclusion The reduced mis- diagnosis, and positive operation resection combined with targeted therapy are the main category to improve the prognosis of GIST.