胃肠道间质瘤29例临床分析

The diagnosis and treatment on gastrointestinal stromal tumors

目的 探讨胃肠道间质瘤 (GIST )的临床特点及诊断治疗。方法 收集我院 2 9例GIST的临床资料进行回顾性分析。结果 本组平均发病年龄 49 5岁。发生部位分别为胃 13例 (44 8% ) ,空肠 7例(2 4 1% ) ,回肠 5例 (17 2 % ) ,十二指肠、小肠系膜、结肠、直肠各 1例 (各 3 4% )。本组病例只有 1例直肠间质瘤术前确诊。 2 9例均行外科手术切除 ,病理证实良性 2 1例 (72 4% ) ,恶性 8例 (2 7 6% )。肿瘤的大小与良恶性相关 (P <0 0 5)。术后随访良性GIST 18例 ,平均随访时间 2 4 6个月 ,16例无局部复发、转移 ;2例术后 1年内复发再手术。恶性GIST 6例 ,平均随访 2 6 4个月 ,3例局部复发再手术 ,1例肝肺转移 ;2例死亡。5例恶性GIST术后辅以不规则化疗 ,但生存期未见明显变化。结论 ①GIST消化道症状无特异性 ,术前确诊率低。②肿瘤的大小是判断良恶性GIST的重要指标。③目前间质瘤的治疗仍以手术切除为主 ,对复发或远处转移者应积极再次手术 。

Objective To investigate the di agnosis,treatment and clinical features of gastrointestinal stromal tumors(GIST) .Methods We retrospectively analyzed 29 patients with GST treat ed in affiliated hospital of guangdong medical college.Results There were 18 males,11 famales with average age of 49.5 years.Tumors located in the stomach in 13 cases(44.8%),jejunum in 7 cases(24.1%),ileum in 5 cases(17.2%) ,and duodenum,mesentery of small intestine,colon and rectum in 1 case(3.4%) resp ectively.The commonest symptoms were abdominal pain and abdominal distention(65. 5%),alimentary tract bleeding(44.8%).We had only a rectum stromal tumor in 1 cas e diagnosed before operation.All the 29 patients were treated surgically.Histolo gy diagnosed as benign humor in 21 cases(72.4%),malignant in 8 cases(27.6%).The size of tumors was correlated with the malignancy of GIST significantly( P<0.05).Benign GIST in 18 cases were followed up for average 24.6 mont hs,16 of them had no local recurrence and metastasis,2 cases of them relapsed an d operated again.Malignant GIST in 6 cases were followed up for average 26.4 mo nths,3 of them with local recurrence were treated with re operation,1 case of t hem had liver and lung metastasis,and 2 cases died.Malignant GIST in 5 postopera tive cases had been irregularly retreated by chemotherapy,however,the survival p eriod of these patients was not be prolonged.Conclusion (1)The confirmed diagnosis rate of preoperative GIST is low and digestive tract sympto ms have no specific.(2)The size of the tumor is the important marker to the diag nosis of benign or malignant GIST.(3)At present,the operation is still the main method to treat GIST.For recurrent or metastatic cases re operation can prolong patients' life.