小肠间质瘤内镜特征和临床病理特点分析

Endoscopic and clinicopathological features of small intestinal stromal tumors

目的分析小肠间质瘤(SIST)的内镜特征、临床病理特点,为术前评估SIST预后提供依据。方法回顾性分析48例术前接受双气囊小肠镜检查,病理诊断为SIST患者的临床资料。分析其内镜特征和临床病理特点,并计算无复发生存时间。结果纳入48例患者,男女比例为1.18:1,40岁以上占比达81.3%(39/48)。极低危组3例,低危组19例,中危组6例,高危组20例。年龄、病程、血红蛋白、白蛋白、血小板、纤维蛋白原在各组间无明显差异,术前D-二聚体水平与SIST侵袭危险度分级相关(P=0.003)。原发部位以空肠(36例)为主,十二指肠(9例),回肠上段(3例),DBE经口路径SIST检出率明显高于经肛路径(P=0.004)。免疫组化指标中,DOG-1、CD117及CD34在SIST中的阳性表达率分别为100%、93.7%、72.9%,Ki-67增值指数表达与SIST侵袭危险度分级相关(P=0.001)。中高危组SIST术后复发率为23.1%(6/26),1、3、5年无复发生存率分别为96.2%、84.3%和75.9%,中位无复发生存时间为68个月。结论SIST临床特征并不明显,术前D-二聚体水平可以协助评估SIST复发风险。优先行经口路径DBE检查能保证SIST高检出率。术后病理免疫组化检测仍是SIST确诊以及预后评估的金标准。

Objective To analyze the endoscopic and clinicopathological characteristics of small intestinal stromal tumor(SIST and provide a basis for the preoperative evaluation of the prognosis of SIST.Methods The clinical data of 48 patients who underwent double-balloon enteroscopy(DBE)and pathologically diagnosed as SIST before surgery were retrospectively studied.The endoscopic and clinicopathological features were analyzed,and the recurrence free survival time(RFS)was calculated.time.Results The ratio of male to female was 1.18:1,and 81.3%(39/48)were over 40 years old.There were 3 cases in the extremely low-risk group,19 cases in the low-risk group,6 cases in the intermediate-risk group,and 20 cases in the high-risk group.There were no significant differences in age,course of disease,hemoglobin,albumin,platelets,and fibrinogen among the groups.The preoperative D-dimer level was correlated with the SIST risk grade(P=0.003).The jejunum was the most common primary site,with 36 cases originating from it,9 cases from duodenum,3 cases from upper ileum.The detection rate of SIST by oral route was significantly higher than that by transanal route(P=0.004).Among the immunohistochemical indexes,the positive expression rates of DOG-1,CD117 and CD34 in SIST were 100%,93.7%,and 72.9%,respectively.The expression of Ki-67 proliferation index was correlated with SIST risk grade(P=0.001).The recurrence rate of SIST in the intermediate&high-risk group was 23.1%(6/26),the 1,3,and 5-year RFS rates were 96.2%,84.3%,and 75.9%,respectively,and the median RFS time was 68 months.Conclusion The clinical features of SIST are not typical.The preoperative D-dimer level can help assess the recurrence risk of SIST.Prioritizing the oral route of DBE examination can ensure a high detection rate of SIST.Postoperative pathological immunohistochemical testing remains to be the criteria for the diagnosis and prognosis evaluation of SIST.