小肠间质瘤并发消化道出血的临床特征分析

Clinical characteristics of small intestinaall stromal tumors complicated with gastrointestinal bleeding

目的 探讨小肠间质瘤的临床特征及其并发消化道出血的危险因素。方法 对我院2012年5月~2021年12月手术治疗的317例原发小肠间质瘤患者进行回顾性分析,其中男167例(52.7%)、女150例(7.3%),中位起病年龄55(46,63)岁,中位病程90(30,365)天。采用多因素logistic回归分析评估小肠间质瘤患者消化道出血的影响因素。结果 所有患者中,小肠间质瘤位于十二指肠112例(35.3%)、空肠113例(35.6%)和回肠92例(29.0%);肿瘤中位直径5.2(3.0,8.0)cm;10.1%合并其他恶性肿瘤。消化道出血(46.4%)是最常见的临床表现,其次是腹痛(21.1%)、体重下降(15.1%)、腹胀(7.3%)、腹部包块(6.6%);并发症包括肠梗阻(5.4%)、间质瘤内出血(4.4%)、肠穿孔(1.3%),23.7%患者无症状。病程长、TNM分期为T2和T3期是小肠间质瘤患者消化道出血的危险因素;诊断间质瘤同期诊断恶性肿瘤、恶性肿瘤家族史、腹痛是其保护因素(P<0.05)。结论 消化道出血是小肠间质瘤患者最常见的临床表现,对于病程长、TNM分期为T2和T3期小肠间质瘤患者需警惕消化道出血的风险。

Objective To explore the clinical features of primary small intestinal stromal tumors and the risk factors for their complication with gastrointestinal bleeding.Methods A retrospective analysis was performed on 317 patients with small intestinal stromal tumor treated by operation in our hospital from May 2012 to December 2021,including 167 males(52.7%)and 150 females(7.3%).The median age of onset was 55(46,63)years,and the median course of disease was 90(30,365)days.Multivariate logistic regression analysis was used to evaluate the influencing factors of gastrointestinal bleeding in patients with small intestinal stromal tumors.Results Among all patients the tumors were distributed in duodenum(35.3%),jejunum(35.7%),and ileum(29.0%);the median tumor was 5.2 cm;10.1%combined with other malignant tumors.Gastrointestinal bleeding(46.4%)was the most common clinical manifestation,followed by abdominal pain(21.1%),weight loss(15.1%),abdominal distension(7.3%),and abdominal mass(6.6%);complications included intestinal obstruction(5.4%),intra-stromal hemorrhage(4.4%),and intestinal perforation(1.3%);23.7%intestinal stromal tumors patients were asymptomatic.A long disease duration and TNM stage T2 or T3 were identified as risk factors for gastrointestinal bleeding in intestinal stromal tumors patients.Conversely,concurrent diagnosis of malignancy,a family history of malignancies,and abdominal pain were protective factors against gastrointestinal bleeding in intestinal stromal tumors patients(P<0.05).Conclusion Gastrointestinal bleeding is the most common clinical manifestation in patients with small intestinal stromal tumor,and the risk of gastrointestinal bleeding should be vigilant in patients with long disease course,TNM stage T2 and T3 small intestinal stromal tumor.