胃肠间质瘤的临床诊断分析

Clinical analysis of the diagnosis of gastrointestinal stromal tumors

目的探讨胃肠间质瘤的临床诊断及治疗特点。方法回顾性分析21例胃肠间质瘤患者的临床资料和治疗方法,辅助检查诊断为GIST的方法有:胃镜、肠镜检查及活检组织病理诊断18例(85.7%),增强CT检查12例(57.1%),超声内镜检查8例(38.1%),上消化道造影1例(4.8%)。21例患者均行手术治疗,采用SPSS13.0统计软件进行数据分析,术后免疫组织化学及危险度分级分析比较采用χ2检验,P<0.05被认为有统计学意义。结果 21例中15例为胃间质瘤,6例为小肠间质瘤。本组患者进行CD117、CD34、S100、和SMA等4项免疫组织化学检测,表达阳性率CD117(95.24%)和CD34(71.43%),CD117,CD34在胃肠间质瘤中表达明显高于S100(9.52%)和SMA(38.09%),χ2=10.00、16.13,P<0.05,差异有统计学意义。中、高危患者口服伊马替尼明显提高生存率。结论 CD117与CD34同时表达有助于临床诊断。手术是胃肠间质瘤的主要治疗方法,靶向药物具有延缓胃肠间质瘤的复发和转移的临床意义。

Objective To investigate the clinical characteristics of diagnosis and therapeutic strategies of gastrointestinal stromal tumors （ GISTs ） . Methods Clinical data of 21 patients with GISTs were retrospectively analyzed, including their clinical manifestations , diagnosis and treatment .The auxiliary diagnosis methods of GIST were employed , including gastroscopy , colonoscopy and biopsy tissue pathological diagnosis in 18 patients （85.7%）, and enhanced CT examination in 12 patients （57.1%）, endoscopic ultrasonography examination in 8 patients （38.1%）, and upper gastrointestinal angiography in 1 patient （4.8%）.All patients underwent surgery and the final diagnosis was based on postoperative pathology and immunohistochemistry .Clinical data were analyzed by using statistical software SPSS 13.0, the risk of postoperative immunohistochemical and hierarchical analysis by the Chi-square test.A P value 〈0.05 was considered statistically significant . Results Among the 21 patients, 15 had gastric stromal tumors , and 6 had small intestinal stromal tumors CD 117, CD34, S100, and SMA were detected by immunohistochemistry in all 21 patients.The positive expression rates were 95.24%in CD117 and71.43%in CD34 in gastrointestinal stromal tumors, which were significantly higher than 9.52%in S100 and 38.09%in SMA respectively （χ^2 =10.00, 16.13, P〈0.05）.The patients with intermediate risk and high risk were treated with imatinib , and their survival rate was significantly improved . Conclusions The simultaneous expressions of CD117 and CD34 are helpful to the clinical diagnosis of stromal stumor .Surgery is the main treatment for GIST , and target drugs for the recurrence and metastasis of the tumor are of clinical significance .