12例伴出血小肠间质瘤的回顾分析及文献复习

A Retrospective Study of 12 Small Intestinal Stromal Tumor with Hemorrhage and the Literature Review

目的回顾性分析伴消化道出血的小肠胃肠道间质瘤(gastrointestinal stromal tumor,GIST)患者的资料并复习相关文献,提高伴消化道出血的小肠GIST的诊治水平。方法收集2017年9月—2020年9月苏州大学附属第一医院收治的伴消化道出血,经胶囊内镜(capsule endoscopy,CE)或双气囊小肠内窥镜检查(double-balloon enteroscopy,DBE)并最终外科病理确诊的初诊小肠GIST患者共12例的临床资料,对内镜和影像学检查结果、肿瘤病理组织学、免疫组化、治疗及临床预后情况进行总结分析。结果12例伴消化道出血的小肠GIST患者中男6例,女6例,平均年龄(62±8)岁。CE的阳性检出率为55.6%(5/9),CT的初步诊断率为58.3%(7/11),DBE的阳性检出率为100%(10/10)。肿瘤平均直径3.9 cm,位于空肠7例,回肠4例,十二指肠1例,腔内型2例,壁内型10例。所有患者均达到R0切除效果,根据NIH危险度分级,低风险和高风险患者分别为9例和3例,中位随访27(11~44)个月,未发现复发及转移。结论CE、CT、DBE等检测方法的交叉运用,有助于提高伴消化道出血的小肠GIST的检出率。伴消化道出血的小肠GIST患者中高危组的比例较低,可能与影响预后的因素在伴或不伴消化道出血的GIST患者中分布不同以及显性出血促使患者早期就诊有关。

Objective To analyze the data of small intestinal GIST patients with hemorrhage and review relevant literature,so as to improve the diagnosis and treatment of GIST with hemorrhage.Methods Since September 2017 to September 2020,12 initially diagnosed GIST patients with gastrointestinal bleeding were collected from First Affiliated Hospital of Soochow University.These cases all completed capsule endoscopy(CE)or double-balloon enteroscopy(DBE)test and were eventually confirmed by surgical pathology.The results of endoscopic and imaging examination,tumor histopathology,immunohistochemistry,treatment and clinical prognosis were analyzed.Results Among the 12 small intestinal GIST patients with hemorrhage,there were 6 males and 6 females with an average age of(62±8)years.The positive detection rate of CE,CT and DBE were 55.6%(5/9),58.3%(7/11)and 100%(10/10).The mean diameter of the tumors was 3.9 cm,7 cases located in jejunum,4 cases in ileum and 1 in duodenum.According to NIH risk classification,9 patients were at low risk and 3 patients were at high risk.No recurrence or metastasis was found after a median follow-up of 27(11-44)months.Conclusion The cross application of CE,CT,DBE and other detection methods can improve the detection rate of small intestinal GIST with hemorrhage.Compared with GIST patients without gastrointestinal bleeding,those patients with hemorrhage have a low proportion of high-risk groups.The reasons may be the different distribution of prognostic factors in GIST patients with or without hemorrhage and early hospital diagnosis and treatment because of overt bleeding.