十二指肠间质瘤29例的诊治分析

Diagnosis and management of duodenal gastrointestinal stromal tumors:a review of 29 cases

目的：探讨十二指肠间质瘤的临床特点与诊疗方法。方法：收集自2000年5月一2012年4月经手术治疗病理证实的29例十二指肠间质瘤患者资料。对其发病情况、临床表现、影像学检查所见、治疗方法、病理结果及预后情况进行回顾性分析。结果：29例中男14例，女15例；平均年龄51．95岁。肿瘤位于球部2例，降部16例，水平部8例，升部3例。首发症状黑便15例，同时呕血及黑便者2例，上腹部胀痛7例，周身乏力2例，无明显症状3例。肿物大小1．5～15．5cm，平均6．9cm；1．5-5cm19例，5～10cm7例，10cm以上3例。术前检查包括CT和／或MRI，胃十二指肠镜，上消化道造影，超声内镜等。患者均行手术治疗，包括7例胰十二指肠切除术；10例十二指肠节段切除术；10例十二指肠局部切除术；2例十二指肠球部及胃窦部切除术。10例术后行伊马替尼治疗。Fletcher危险度分级为极低危险度2例，低度危险11例，中度危险9例，高度危险7例。免疫组化结果显示，CD34（＋）23例，CDl17（＋）27例。共27例获得随访，随访时间12～156个月，平均54个月，5例复发，其中2例肝转移，3例局部复发。复发中有2例未行进一步治疗分别于术后30个月和42个月病死。结论：根治性手术切除是十二指肠间质瘤的有效治疗手段。手术方式取决于肿瘤大小和部位。如能保证切缘阴性，局限性切除可获得较好的效果。

Objective： To investigate the clinical characteristics, diagnosis and treatment methods of duodenal gastrointestinal stromal tumors （GIST）. Methods： Data of 29 patients with pathologically proven duodenal GIST undergoing surgery from May 2000 to April 2012 were collected. The onset of the disease, clinical manifestations, imageological findings, treatment methods, pathological results and prognosis of these patients were retrospectively analyzed. Results： Of the patients, 14 were male and 15 were female with an average age of 51.95 years. The lesions were located in the bulb （2 cases）, descending part （16 cases）, horizontal part （8 cases）, and ascending part （3 cases） of the duodenum, respectively. The initial symptoms were melena in 1S cases, hematemesis combinedwith melena in 2 cases, bloating and pain in upper abdomen in 7 cases, and general fatigue in 2 cases, while 3 cases demonstrated no overt symptoms. The tumor size ranged from 1.5 to 15.5 cm with an average of 6.9 cm, which was 1.5-5.0 cm in 19 cases, 5.0-10.0 cm in 7 cases, and 〉10 cm in 3 cases. ~he preoperative examinations comprised CT scan and/or MRI, gastroduodenoscopy, upper gastrointestinal contrast, and endoscopic ultrasonography. All patients underwent surgical treatment that included pancreaticoduodenectomy in 7 cases, segmental duodenal resection in 10 cases, local duodenal resection in 10 cases, and duodenal bulb plus gastric antral resection in 10 cases; 10 patients were treated with imatinib after surgery. According to Fletcher＇s risk classification, tumors in 2 cases were very low risk, in 11 cases were low risk, in 9 cases were intermediate risk, and 7 cases were high risk. Immunohistochemical results showed tumors in 23 cases were CD34 positive and in 27 cases were CD117 positive. Follow-up in 27 patients was obtained for 12 to 156 months, with an average of 54 months. Recurrence occurred in 5 patients, of whom 2 cases developed liver metastases and 3 had local recurrence. Two of the recurrent cases received no further treatment and died 30 months and 42 months later, respectively. Conclusion： Radical resection is effective treatment for duodenal GIST. The procedure used depends on the the size and location of the tumor. Better results can be expected under the premise of a negative surgical margin.