胃肠道神经鞘瘤的诊断与治疗

Diagnosis and treatment of gastrointestinal schwannoma

目的探讨胃肠道神经鞘瘤的临床表现、诊断、鉴别诊断和治疗方法。方法对山东大学齐鲁医院于2015年6月收治的2例胃神经鞘瘤患者和1例小肠恶性神经鞘瘤患者的临床表现、辅助检查及治疗情况等临床资料进行回顾性分析。结果本组3例胃肠道神经鞘瘤患者的临床表现无特异性，多数无症状，可表现为上腹不适、饱胀、反酸等消化道症状。X线、消化内镜、B超、MRI及CT检查均无特殊征象，术前常被误诊为胃肠道间质瘤、胃平滑肌（肉）瘤和胃癌。本组3例患者术前均被诊断为胃肠道间质瘤，术后病理确诊为神经鞘瘤。结论神经鞘瘤无特异性临床表现，影像学检查亦无特异征象，术前确诊困难，确诊需要依赖术后病理检查，手术切除是最有效的治疗方法。

Objective To analyze the clinical characteristics, diagnosis, differential diagnosis and treatment of gastrointestinal schwannoma. Methods Clinical data of 3 patients with gastrointestinal sehwannoma were collected and retrospectively analyzed. Results Gastrointestinal bleeding or melena, anemia and epigastrie pain were the most common presenting symptoms. The symptoms, physical signs and auxiliary examinations （such as X-ray, ultrasonography and gastrointestinal endoscopy ） of gastrointestinal schwannoma had no value in differentiation. In all the 3 patients definite diagnosis was achieved only by postoperative pathology. Conclusion Gastrointestinal schwannoma are derived from the Schwann cells of nerves in gastrointestinal wall and are usually benign. Benign schwannomas can only be distinguished from the malignant ones on the basis of histological and immunohistoehemical criteria. Surgical resection is the most effective treatment.