64例小肠间质瘤临床诊治分析

Analysis of clinical diagnosis and treatment of 64 cases of small intestinal stromal tumor

目的探讨小肠间质瘤(SIST)的临床特征、危险因素、诊治方法及预后。方法对该院2012年12月至2016年8月经病理组织学证实的64例SIST患者的临床资料和随访资料进行回顾性分析。结果 64例SIST患者中,间质瘤位于近端小肠45例(70.3%),远端小肠19例(29.7%)。SIST临床表现不典型,首发症状为消化道出血30例(46.9%),腹痛18例(28.1%),腹部包块8例(12.5%),腹胀5例(7.8%),恶心呕吐3例(4.7%)。螺旋CT对SIST的检出率为98.2%,诊断符合率为57.9%,在各种检查中最高。64例SIST患者术后病理结果显示极低、低、中、高危险度分别为8例(12.5%)、22例(34.4%)、3例(4.7%)、31例(48.4%)。近、远端SIST在肿瘤直径、核分裂象数、肿瘤危险度及Ki-67阳性率间差异有统计学意义(P<0.05),近、端SIST大多直径小于或等于5cm,核分裂象数小于或等于5/50高倍视野(HPF),Ki-67阳性率低于远端SIST。肿瘤直径、核分裂象数、是否服用伊马替尼、肿瘤危险度是影响SIST复发的危险因素。结论消化道出血是SIST最常见的临床表现,近端SIST发病率高于远端SIST,螺旋CT是最有效的检查方法,远端SIST恶性程度高于近端SIST,且较近端SIST更易复发、转移。

Objective To investigate small intestinal stromal tumors(SIST)of the clinical features,risk factors,diagnosis and treatment methods,and prognosis.Methods A retrospective analysis of clinical data and follow-up data of 56 SIST patients who had been confirmed by our department from December 2012 to August 2016.Results Of the 64 patients with SIST,45 were proximal small intestine(70.3%)and 19 were the distal small intestine(29.7%).The clinical manifestation of SIST is not typical,the first symptoms were digestive tract hemorrhage in 30 cases(46.9%),abdominal pain in 18 cases(28.1%),abdominal mass in 8 cases(12.5%),abdominal distention in 5 cases(7.8%),nausea and vomiting in 3 cases(4.7%).The detection rate of spiral CT for SIST was 98.2%and the diagnostic coincidence rate of spiral CT for SIST was 57.9%,which was the highest in all the examinations.The postoperative pathological findings of 64 patients with SIST showed:8 cases of very low risk(12.5%),22 cases of low risk(34.4%),3 cases of moderate risk(4.7%)and 31 cases of high risk(48.4%).There were differences in tumor diameter,mitotic figures,tumor risk and Ki-67 positive rate between the proximal and distal SIST(P<0.05).The proximal SIST are less than equal to 5cm in diameter,and mitotic index less than equal to 5/50 high power field(HPF).The positive rate of Ki-67 in the proximal SIST is lower than that in the distal SIST.Tumor diameter,tumor nucleus mitotic counts,imatinib therapy and risk factors were correlated with SIST recurrence.Conclusion Gastrointestinal bleeding is the most common clinical manifestation of SIST and the incidence of proximal SIST is higher than that of distal SIST.Among the various methods of examination,spiral CT is the most effective means of inspection.The malignancy of the distal SIST is higher than that of the proximal SIST,and the distal SIST is more likely to relapse and metastasis than the proximal SIST.