胃神经鞘瘤的临床特点及诊治（附21例报告）

Clinical features, diagnosis and treatment of gastric schwannomas： a report of 21 cases

目的分析总结胃神经鞘瘤的临床特点、诊断及治疗方法。方法回顾性分析我们于2000年1月至2013年12月间收治的21例胃神经鞘瘤的临床病例资料，回顾参数包括一般资料统计、临床表现、诊断方法及治疗方法等。结果主要临床表现为腹痛、腹部肿块和上消化道出血。术前经B超、上消化道钡剂造影、胃镜、CT及超声内镜检查，仅确诊2例，余均误诊。本组均手术治疗，行胃局部切除术6例，胃大部分切除术13例，根治性胃次全切术2例。2例恶性胃神经鞘瘤病人分别于术后14个月和36个月死于肺转移，良性者效果良好。结论胃神经鞘瘤是一种比较罕见的间质源性肿瘤，临床表现缺乏特异性，术前确诊率低，临床上以良性多见，该病对化疗、放疗不敏感，手术切除是治疗的唯一方法。

Objective To explore the clinical characteristics, diagnosis and treatment of gastric schwannomas. Methods The clinical data of 21 patients of gastric sehwannomas were retrospectively analyzed from January 2000 to December 2013. Results Their clinical manifestations included abdomi- nal pain, abdominal mass and upper gastrointestinal hemorrhage. The preoperative diagnosis was based on type B ultrasound, barium enema, gastroscope, computed tomography （CT） and endoscopic ultrasound （EUS）. Only 2 cases were corrected diagnosed while the remainder all misdiagnosed. All patients underwent the procedures of gastric resection （n = 6）, subtotal resection （n = 13） and radical subtotal gastreetomy （n = 2）. Two patients with malignant gastric sehwannomas died of postoperative pulmonary metastasis at 14 and 36 months respectively. The operative outcomes of benign gastric schwannomas were generally fair. Conclusions Gastric schwannomas are rare mesenchymal tumors with non-specific clinical features and low rates of preoperative diagnosis. Most tumors are benign and insensitive to chemo radiotherapy. Operation is the only curative treatment.