37例小肠恶性间质瘤的临床诊治分析

目的探讨小肠恶性间质瘤的临床及病理学表现、诊断和治疗。方法回顾性分析37例小肠恶性间质瘤患者的临床资料。结果所有病例均经手术后病理确诊为小肠恶性间质瘤。主要起源于空肠（19例，51.4％），其次为十二指肠（10例，27.0％）。33例（89.2％）有临床症状，最常见的临床表现为消化道出血（13例，39.4％）、腹痛和（或）腹部不适（10例，30.3％）及腹部包块（10例，30.3％）。胶囊内镜阳性率最高（100％，3／3），其次为超声胃镜（80％，4／5）、血管造影（62.5％，5／8）和CT（44.0％，11／25），31例经剖腹探查明确诊断。免疫组化：CD117和CD34的阳性率分别为94.6％（35／37）和81.1％（30／37）。全部病例均行外科手术治疗。随诊1-60个月，11例复发，其中8例口服伊马替尼疗效显著。结论CD117是小肠恶性间质瘤的诊断性标志物，完整的病灶切除是最有效的治疗方法，对无法切除的晚期病人及术后病人应及时应用伊马替尼进行治疗。

Clinical diagnosis and therapy of 37 patients with gastrointestinal stromal tumors in small intestine

Objective To investigate the manifestation, pathology, diagnosis and therapy of gastrointestinal stromal tumors （GIST） in small intestine. Methods The clinical data of 37 patients with gastrointestinal stromal tumors in small intestine, collected from Tongji Medical College of HUST from February 2002 to July 2008 were analyzed retros pectively. Results All cases were pathologically diagnosed as malignant tumors after operation. Most of them occurred in the jejuno （51.4%） and less commomly in the duodenum （27.0%）. Thirty-three cases （89.2%） were symptomatic, including gastrointestinal bleeding （39.4%）, abdominal pain and/or uncomfortability （30.3%） and abdominal mass （30.3%）. The highest positive rate was capsule endoscopy （100%,3/3）, followed by ultrasonic endoscope （80% ,4/5）, angiography（62.5%, 5/8） and CT （44.0%, 11/25 ）. Thirty-one cases were diagnosed by exploratory laparotomy. The positive immunohistochemical rate of CD117 and CD34 were 94.6% （35/37） and 81. 1% （30/37） respectively. All patients were treated by surgery operation. During 1 months to 5 years＇ s follow-up, 11 patients recurred. For recurring patients, the tumors decreased obviously in 8 recurring patients who took hnatinib for 3 to 28 months. Conclusion The positive staining of CD117 is an important symbol of GIST. The most effective treatment is the complete focus resection. Imatinib should timely apply for patients after operations and advanced stage patients who can＇ t operation.