胃肠道间质瘤56例临床诊断及外科治疗分析

Surgical treatment and diagnosis of 56 cases of gastrointestinal stromal tumors

目的探讨胃肠道间质瘤(GIST)的临床特点及诊治方法。方法对南京医科大学附属无锡市第二人民医院1998年1月至2008年3月间收治的56例胃肠道间质瘤病人进行回顾性分析。结果肿瘤最常见于胃部62.5%(35/56),其次为十二指肠5.4%(3/56)、空肠12.5%(7/56)、回肠17.9%(10/56)、结肠1.8%(1/56)。以恶性肿瘤多见,占67.9%(38/56),交界性19.6%(11/56),良性12.5%(7/56)。56例均获手术治疗。术后病理检查均无淋巴结转移。术后随访12个月至8年,48例获完整随访,1年、5年存活率分别为100%和78.57%。结论胃肠道间质瘤好发于胃,依次为小肠、结肠,以恶性者多见,其局部侵袭性不如消化道恶性肿瘤,淋巴结转移少见,术前诊断主要依据影像学检查、内镜及病理CD117和CD34阳性标记是确诊GIST有价值的免疫标记物;手术切除为主要治疗方法,其手术方式的选择多取决于肿瘤的部位和大小。

objective To investigate clinical characteristics and surgical effect of gastrointestinal stromal tumors(GISTs).Methods Clinical data of 56 cases from 1998 to 2008 in our department were analyzed and 48 cases were closely followed up after the surgery.Results The lesions mainly located in the stomach(62.5%),unusually in the duodenum(5.4%),the jejunum(12.5%%),and ileum(17.9%),rarely in the colon(l.8%).Pathological examination revealed 7 cases of benign tumor.11 cases of borderline tumor and 38 cases of malignant tumor,and microscopically,the tumors were composed of spindle cells(43 cases),or epithelial cell(2 cases),or both of two cell types(11 cases).CD117 in 48 cases.All the 56 patients received surgical resection.The 1 and 5-years survival rates were 100%and78.57%,respectively.Conclusion Most GISTs are malignant with minor lymphatic metastasis,mainly located in stomach,unusually in the small bowel,rarely in colon and rectum,and less invasive than carcinoma.Preoperative diagnosis is mainly depended on endoscopy,imageology and pathology examinations.Application of immunohistochemical markers(CDI17,CD34) is necessary for differential diagnosis.Therapeutic option is mainly depended on surgery,which is determined by the location and size of the tumor.