胃间质瘤31例临床分析

Clinical analysis of 31 patients with gastric stromal tumors

目的 探讨胃间质瘤的临床表现、诊断和治疗方法。方法 回顾分析资料完整、病理诊断明确的 31例胃间质瘤患者 ,依据诊断标准对胃间质瘤进行分类。结果 胃间质瘤无明显的性别差异 ,50～ 60岁为发病高峰。好发部位为胃底部 ,其次为胃体部 ,胃窦部发生较少。其中恶性胃间质瘤占 58 1 % (1 8/ 31 ) ,良性胃间质瘤仅占 2 5 8% (8/ 31 )。交界性胃间质瘤的病程较长 ,平均为 79个月 ,恶性胃间质瘤的病程较短 ,平均为 4个月。本病临床表现无特异性 ,主要为上消化道出血、上腹不适和 (或 )腹胀、腹痛等。胃镜、超声胃镜、上消化道钡餐造影或B超及CT影像学等检查可以发现肿瘤 ,通过病理组织学及免疫组化检查可明确诊断。本病首选手术治疗 ,对伴有肝转移者可采取经肝动脉导管栓塞化疗 ,但疗效不肯定。结论 胃间质瘤是一类独立的胃黏膜下肿瘤 ,过去诊断为平滑肌或神经源性肿瘤的某些梭形细胞肿瘤 。

Objective To investigate the clinical manifestations, diagnosis and treatment of gastric stromal tumors. Methods 31patients with gastric stromal tumors treated from 1993,1 2001,9 were analyzed retrospectively. All cases were diagnosed by pathological and immunohistochemistry examinations. According to Levin′s standard combining with Hurliman′s and Goldbum′s methods, the patients were classified. Results There are no significant difference between male and female patients. 50 60 years old patients have high incidence. The distribution of gastric stromal tumors is fundus>body>antrum. Diagnosis of this condition is sometimes difficult and treatment is often delayed because patients usually present with nonspecific abdominal symptoms. The main manifestations of gastric stromal tumors are upper gastrointestinal hemorrhage 61.3%(19/31),7 patients with acute hemorrhage and 12 with chronic hemorrhage.Most of them were malignant .Abdominal malaises and/or distention 32.3%(10/31)and abdominal pain 22.6%(7/31). Gastroscopy ,ultrasound gastroscopy ,computed tomography, B type ultrasound and upper gastrointestinal X ray series are helpful to diagnosis. But the final diagnosis is decided by pathological and immunohistochemistry examinations. Gastric stromal tumors exhibit consistent immunohistochemical expressions of CD 117 and/or CD 34 .The operative treatment is thought of the first choice. Effect of the chemotherapy isn′t satisfied .There is no standard chemotherapy for gastric stromal tumors. Conclusions Gastric stromal tumor is a kind of separated submucosal tumor which is different from leiomyoma ,leiomyosarcoma and neurogenic tumors. Pathological and immunohistochemistry inspectations are very important to make clear diagnosis.Early diagnosis and rational treatment are the keys to improve the prognosis.