胃肠道间质瘤的诊治分析

Clinical analysis of diagnosis and treatment of gastrointestinal stromal tumors

目的 探讨胃肠道间质瘤的临床特征及诊治经验.方法 对2003年1月至2013年6月收治的共72例胃肠道间质瘤的临床病例进行回顾性分析.结果 72例胃肠道间质瘤患者中男性37例、女性35例,中位年龄61岁.发病部位：胃41例（56.94％）,小肠24例（33.33％）,结直肠6例（8.33％）,食管1例（1.39）.主要临床表现依次有腹痛、消化道出血、腹部肿块、肠梗阻、贫血.免疫组织化学检测CD117、CD34、SMA、DOC-1、S-100阳性率分别为98.61％（71/72）、70.83％（51/72）、34.72％（25/72）、100.00％（18/18）、5.56％（4/72）.所有患者均行手术治疗,其中2例行姑息性手术,其余70例均完整切除.21例行伊马替尼治疗,完全缓解（CR）3例,部分缓解（PR）16例,疾病稳定（SD）2例.1、3、5年生存率分别为93.79％、79.54％、53.69％.结论 胃肠道间质瘤临床表现不典型,确诊依靠组织学检查及免疫组织化学检查.手术完整切除联合靶向药物治疗可使胃肠道间质瘤患者获得满意疗效.

Objective To explore the diagnosis and treatment of gastrointestinal stromal tumors （GIST）.Methods Retrospective analysis was performed on the clinical data of 72 cases of GIST from January 2003 to June 2013.Results There were 37 males and 35 females with a median age of 61 years old.Tumors located at stomach,small intestine,colorectum and esophagus were 41 cases （56.94％）,24 cases （33.33 ％）,6 cases （8.33％）,1 cases（1.39％）.The common clinical presentations were ab dominal pain,gastrointestinal bleeding,abdominal mass,intestinal obstruction,anemia.Immunohis tochemistry staining revealed that the positive rate of CD117,CD34,SMA,DOG-1,S-100 was 98.61％（71/72）,70.83％ （51/72）,34.72％ （25/72）,100.00％ （18/18）,5.56％ （4/72）.The whole group was performed surgical treatment,70 patients underwent R0 resection and 2 R1 resection due to extensive invasion.Twenty one patients received imatinib mesylate therapy after surgery,in which 3 cases obtained complete response,16 cases partially response and 2 stable disease.The 1,3,5 year survival rates were 93.79％,79.54％m 53.69％,respectively.Conclusions The clinical presentation of GIST is atypical.The final diagnosis depends on pathological and immunohistochemical examina tion.Surgery combined with targeted therapy can achieve satisfactory outcomes in patients with GIST.