小肠平滑肌肉瘤8例的诊断和治疗

Diagnosis and treatment of small intestinal leiomyosarcoma: analysis of 8 cases

目的探讨小肠平滑肌肉瘤的临床表现、术前诊断和治疗。方法对8例小肠平滑肌肉瘤病例的临床表现、影像学检查、诊断、术中所见及手术方法进行总结分析并复习相关文献。结果术前3例考虑为小肠平滑肌肉瘤,1例考虑为空肠血管瘤;误诊为肠套叠1例,卵巢肿瘤2例,盆腔肿瘤1例;1例行胰十二指肠切除术,4例行根治性小肠平滑肌肉瘤切除术,其余3例因侵犯广泛而无法切除。4例术后2年内死亡,其余4例目前仍存活,无复发。结论小肠平滑肌肉瘤缺乏特征性的临床表现而常常被误诊,影像学检查有助于术前诊断,手术切除是目前唯一有效的的根治性治疗方法。

Objective To investigate the clinical findings, the preoperative d iagnosis and the treatment of small intestinal leiomyosarcoma. Methods Clinical findings, imaging examinations,diagnosis, intraoperative findings and operative styles of 8 cases with small intestinal leiomyosarcoma were analyzed retrospect ively and the literature was reviewed. Results 3 cases were considered as small intestinal leiomyosarcoma and 1 case was considered as jejunal haemangioma preop eratively. 1 case was misdiagnosed intussusception, 2 cases were misdiagnosed ov arian tumor and 1 case was misdiagnosed pelvic tumor preoperatively. 1 patient u nderwent pancreatoduodenectomy, 4 patients underwent radical resection of small intestinal leiomyosarcoma. The tumors of the other 3 patient were not been remov ed because of extensive invasion. 4 cases died in duration 2 years after operati on. The other 4 cases are still alive without evidence of recurrence. Conclusion Lack in characteristic of clinical findings of small intestinal leiomyosarcoma usually causes misdiagnosis. Imaging examinations are significant for its preope rative diagnosis. Resection is the unique effective means for the radical treatm ent of small intestinal leiomyosarcoma.