小肠间质瘤的诊断与治疗

目的探讨小肠间质瘤的临床表现、病理免疫组织化学特征与治疗方法。方法回顾性分析2007年1月-2011年7月70例小肠间质瘤患者的临床表现,免疫组织化学特征及治疗手段。结果小肠间质瘤患者并无特异性临床表现,主要临床表现包括腹痛、腹胀、血便,腹部包块等。极低风险5例,低风险18例,中风险13例,高风险34例。免疫组织化学显示CD117、DOG1、CD34、S-100、平滑肌肌动蛋白(SMA)、增殖细胞核抗原(Ki-67)、人结蛋白(Desmin)的阳性率分别为95.7%(67/70)、100%(11/11)、51.4%(36/70)、5.7%(4/70)、12.9%(9/70)、60.0%(42/70)、0%(0/70)。治疗上主要以手术完整切除为主,伊马替尼主要用于无法切除,转移或中、高危险度的患者。结论小肠间质瘤患者临床表现缺乏特异性表现,发现时往往肿瘤较大、风险度高,选择合理的辅助检查方法可以提高其检出率,目前手术是首选的治疗方式。

Diagnosis and Treatment of Gastrointestinal Stromal Tumor of Small Intestine

Objective To investigate the clinical,pathological,immunohistochemical characteristics of gastrointestinal stromal tumor(GIST) of small intestine and its treatment.Methods Clinical data of 70 patients with small intestine GIST were retrospectively studied between January 2007 and July 2011.Clinical manifestations,immunohistochemical characteristics and treatments were analyzed.Results No specific clinical manifestations were found,and the main clinical manifestations were abdominal pain,distension,melena and abdominal mass etc.There were 5 very low-risk cases,18 low-risk cases,13 intermediate-risk cases,and 34 high-risk cases.Immunohistochemistry showed that 95.7%(67/70),100%(11/11),51.4%(36/70),5.7%(4/70),12.9(9/70),60.0%(42/70),and 0%(0/70) of the patients were positive for CD117,DOG1,CD34,S-100,SMA,Ki-67,and Desmin respectively.Operation removal was the main treatment for small intestine GIST.Imatinib was used when the tumor was unresectable,distant metastasis was found,or the patients were with intermediate or high risks.Conclusions Clinical manifestations of intestinal GIST exhibit no distinct characteristics.Most cases are in high risks with giant mass when they are identified.The diagnostic rate can be improved by rational examinations.So far,the most effective therapy is operational removal.