胃肠道间质瘤的临床与病理关系分析

目的探讨胃肠道间质瘤的临床表现与病理学特征的关系。方法回顾分析本院1995～2003年收治的34例胃肠道间质瘤的临床和病理资料。结果本组病例中位年龄57岁,肿瘤位于胃20例(59%),小肠7例(20%),大肠4例(12%),食道3例(9%)。主要症状有腹痛(59%),消化道出血(26%)。病理诊断良性15例,恶性19例,良性肿瘤平均大小为4.1cm,恶性平均为10.8cm。CD34、CD117、S鄄100阳性表达率分别为65%、64%和47%,其阳性表达与肿瘤良恶性无关(P>0.05)。结论肿瘤免疫表型与良恶性无关。无论是良性还是恶性间质瘤,手术都是目前最重要的治疗手段。     

胃肠道间质瘤的诊断和治疗

目的 总结胃肠道间质瘤的诊断与治疗经验。方法 回顾性总结分析27例胃肠道间质瘤的临床和病理资料。结果 本组胃间质瘤21例,十二指肠间质瘤4例,小肠间质瘤2例。临床表现为消化道出血者16例(59.3％),其中腹痛伴消化道出血者7例;腹痛13例(48.1％),其中上腹部疼痛者6例;以腹部肿块就诊者5例(18.5％)。25例行胃镜检查,确诊为间质瘤2例,发现病变部位22例。2例伴消化道大出血者急诊数字式减法血管造影(DSA)发现病变部位。病理诊断为良性间质瘤12例、交界性13例、恶性2例;良性间质瘤核分裂像和肿瘤直径均显著小于交界性和恶性者(P<0.05)。本组均行手术局部切除治疗,术后发生肺部感染2例,胃排空障碍1例。21例患者术后随访3～24个月,除1例小肠恶性间质瘤患者术后20个月腹壁切口复发外,其余20例均无肿瘤转移复发。结论 内镜和影像学检查对胃肠道间质瘤病变定位有重要作用,胃肠道间质瘤的确诊依靠病理学检查。手术局部切除是治疗胃肠道间质瘤的有效手段。     

恶性胃肠道间质瘤34例临床分析

目的探讨恶性胃肠道间质瘤临床、病理特点。方法回顾性分析2002—2004年收治的34例恶性胃肠道间质瘤的临床和病理资料。结果病人临床表现中腹痛与消化道出血较常见，发生部位最常见为小肠和胃；肿块平均直径10．2cm；术后均经病理学诊断为恶性。术后12例复发，4例死亡。结论肿瘤大小、位置、核分裂像、免疫组化指标是判断胃肠道间质瘤良、恶性的重要指标，对病人诊断为恶性或潜在恶性的胃肠道间质瘤必须进行包括手术治疗在内的综合治疗。     

良恶性胃肠道间质瘤的螺旋CT特征分析

目的探讨良、恶性胃肠间质瘤的螺旋CT特征。方法回顾性分析23例经手术病理证实的胃肠间质瘤的CT影像特点,所有病例均行16层螺旋CT平扫和增强扫描,着重分析病灶的位置、大小及有无坏死等。结果 23例中,22例单发,1例多发;13例为恶性,10例为良性。10例良性肿瘤中,8例直径小于5cm;13例恶性病变中,10例直径大于5cm。若以病灶直径大于或等于5cm作为判断恶性的标准,则敏感度为77%（10/13）,特异度为80%（8/10）,准确性为78%（18/23）。10例良性病灶中,4例出现坏死;13例恶性病灶中,11例出现坏死。如以出现坏死为判断恶性的标准,则敏感度85%（11/13）,特异度为60%（6/10）,准确性为74%（17/23）。结论 CT增强扫描有利于胃间质细胞瘤的定位诊断和良、恶性判断。     

胃肠道间质瘤47例临床分析

目的探讨胃肠道间质瘤(GIST)的诊断、免疫组化特点、良恶性的判断和治疗。方法回顾性总结分析47例GIST的临床和病理资料。结果本组GIST位于胃30例,小肠13例,结肠3例,肛管1例;28例行胃镜检查,确诊4例,发现病灶21例,8例行超声胃镜并穿刺活检,6例确诊;CD117阳性率为82.97%(39/47),CD34阳性率为93.61%(44/47);病理诊断良性间质瘤13例,交界性7例,恶性27例。本组均行肿瘤局部切除或局部消化道部分切除,获得随访的11例良性间质瘤患者全部存活,24例恶性及6例交界性间质瘤患者1例复发,3例发生转移,8例死亡。结论超声内镜结合胃肠道影像学检查是临床诊断的主要方法,确诊需依靠组织病理学检查和免疫组化染色,手术局部切除是有效的治疗手段。     

CTA对小肠间质瘤的诊断价值

目的 评价螺旋CT与螺旋CT血管造影(MSCTA)对小肠间质瘤的诊断价值.方法 回顾性分析19例经手术病理证实小肠间质瘤的螺旋CT扫描与MSCTA结果.结果 19例中良性12例,恶性7例;肿瘤大小约2～15 cm.19例中CT及MSCTA发现病灶有16例,即定性诊断准确率为84.21%.根据手术中探查结果,CT及MSC...     

十二指肠间质瘤的临床特征及外科治疗

目的探讨十二指肠间质瘤的临床特征及外科治疗效果. 方法回顾性分析我科1990～2004年14例十二指肠间质瘤的临床资料. 结果病理类型:良性2例,潜在恶性4例,恶性8例.50.0%(7/14)发生在降部,其中恶性占57.1%(4/7).临床表现为右上腹肿物(6/14),右上腹隐痛不适(5/14)和乏力、体重下降(3/14),诊断手段为十二指肠低张造影(13/14)、B超(13/14)和CT(9/14).肿瘤距离十二指肠大乳头＜3 cm或位于降部、直径≥5 cm者宜行胰十二指肠切除术,肿瘤距离十二指肠大乳头＞3 cm及较小者宜行十二指肠节段性切除术. 结论十二指肠间质瘤恶性多见,临床表现无特异性,主要依靠十二指肠低张造影、B超、CT、EUS确诊,对无远处转移的肿瘤应积极争取根治性切除.     

胃肠道间质瘤临床诊治分析: 附46例报告

目的:探讨胃肠道间质瘤（GIST）的临床表现、病理特点及诊断、治疗和预后。方法:回顾性分析6年间收治的46例GIST患者的临床和病理资料。结果:GIST主要表现为腹部不适、消化道出血、腹部肿块、贫血。术前胃镜检查发现肿块27例;肠镜发现肿块5例;CT发现肿块17例;B超发现肿块13例。术中本组术前诊断率10.8%。肿瘤部位：胃27例，十二指肠3例，小肠10例，结肠5例，直肠1例。良性13例，交界性8例，恶性25例（其中肿瘤直径≥5 cm的占20例，<5 cm5例。）行胃楔行切除术13例，近端胃切除术8例，远端胃切除术6例，全胃切除术1例，胰十二指肠切除术1例，病变肠段切除14例，左半结肠切除术1例，Dixon术1例，旷置术1例。术中均未见淋巴结转移。本组所有恶性患者均未进行放疗或化疗，1例服用格列卫治疗。随访6～48个月，良性和交界性患者无复发;恶性患者中2例胃恶性间质瘤术后26个月死于肝转移，1例结肠恶性间质瘤术后死于局部复发、腹腔转移。结论:GIST无特异性临床表现，术前诊断困难。内镜和CT、超声是临床检查的主要方法。手术切除是主要的治疗手段，切除范围决定于术中快速冰冻切片检查的结果和肿瘤大小等指标对其良、恶性的判断。     

小肠间质瘤的CT诊断

目的探讨小肠间质瘤的CT诊断价值,提高对小肠间质瘤CT征象和临床表现的认识。方法回顾性分析14例经手术病理及免疫组化证实的小肠间质瘤患者的临床资料。临床主要症状为黑便、贫血、腹部不适、腹痛、呕吐、发热及腹部包块等。所有病例均行CT平扫及增强扫描。结果本组病例中,CT共检出病灶14个,均为单发,发生于十二指肠3例,回肠7例,空肠4例。良性9例,CT平扫表现为类圆形软组织块影,瘤体最大径均≤4.0cm,密度均匀,明显均一强化。恶性5例,分叶状或不规则形,瘤体最大径均〉4.0cm,多为腔外生长,肿瘤内可见囊变坏死,不均一强化,其中肝脏及肺转移各1例。结论 CT对小肠间质瘤具有重要诊断价值;以瘤体最大径4.0cm为界值对肿瘤的良恶性判断有一定参考价值。     

胃肠道间质瘤48例临床分析

目的探讨胃肠道间质瘤(GIST)的诊断、临床病理特征、良恶性的判断和外科治疗。方法回顾性分析48例GIST的临床和病理资料。结果本组GIST位于胃27例,小肠14例,结肠5例,肛管2例。27例行胃镜检查,确诊4例,发现病灶21例,其中8例行超声胃镜并穿刺活检,6例确诊。CD117阳性率为89.6%(43/47),CD34阳性率为69.5%(33/47)。病理诊断良性间质瘤13例,交界性8例,恶性27例。本组均行肿瘤局部切除或局部消化道部分切除。48例随访6～60个月,13例良性间质瘤患者全部存活,27例恶性及8例交界性间质瘤患者中1例于术后8月复发,3例术后16月发生转移,8例术后36月死亡。结论超声内镜结合胃肠道影像学检查是临床诊断GIST的主要方法,确诊需依靠组织病理学检查和免疫组化染色,外科手术完整切除是原发GIST最主要的治疗方式。     

62例胃肠道间质瘤的临床诊治分析

目的探讨胃肠道间质瘤的临床表现特点和疗效。方法对我院1998年1月-2006年12月收治的62例胃肠道间质瘤病人的临床资料进行回顾性分析。结果病理结果显示：恶性病变25例，交界性病变5例及良性病变32例。免疫组织化学检测提示：CD17阳性48例（78％），CD34阳性45例（72．5％），SMA阳性17例（27．8％）以及S100阳性13例（20．5％）。所有良性及交界性病变的患者无术后复发。25例恶性患者中有12例手术后1至5年复发，表现为腹内转移或肝转移。其中8例死于肝转移引起的全身衰竭，2例分别于术后12个月及18个月发现肝转移，但至今仍带瘤存活。结论通过病理组织学及免疫组化检查可明确本病的诊断。手术切除肿瘤治疗结合可获得较满意的疗效。     

小肠间质瘤相关临床特征分析

目的 总结小肠间质瘤相关临床特征.方法 回顾性分析我科自2007年至2012年收治的31例小肠间质瘤患者的临床资料及随访资料.以腹部隐痛不适表现者7例,肠梗阻表现者8例,腹部包块表现着3例,消化道出血者11例,2例表现为纳差乏力等全身症状;术前行CT检查20例,11例诊断间质瘤,B超诊断9例,未能作出间质瘤诊断,上消化道造影3例,1例做出间质瘤诊断,内镜检查8例,4例做出间质瘤诊断;术后均行免疫组织化学检测：按照NIH分级：低风险度9例,中风险度5例,高风险度17例.结果 术后随访,复发10例,复发时间最短1个月,最长3年,中位时间18个月,复发后出现肝转移及网膜转移患者7例.结论 小肠间质瘤起病隐匿,缺乏临床特异性,术前诊断困难,术后更易复发.     

Gastric stromal tumors: a clinicopathologic study of 77 cases with correlation of features with nonaggressive and aggressive clinical behaviors

Gastrointestinal stromal tumors are a heterogeneous group of neoplasms that have clinical and histologic features that vary depending on their location within the gastrointestinal tract. Prediction of clinical behavior in this group of tumors is notoriously difficult, and the same criteria for malignancy do not necessarily apply to stromal tumors from different sites within the gastrointestinal tract. Using known clinical behavior with long-term follow-up, we attempted to determine which features, if any, are associated with clinical behavior in stromal tumors arising in the stomach, the most common site for such tumors. Seventy-seven gastric stromal tumors were studied and classified as "adverse outcome (AO) tumors" (malignant) or "nonadverse outcome tumors" (benign) based on their known clinical outcome. AO was defined as metastasis and/or death due to tumor. Patients with a non-AO had at least 5 years of tumor/metastasis-free follow-up. Thirty-seven patients had an AO (follow-up [metastasis at presentation] 0-73 months; median 6 months), and 40 patients had a non-AO (follow-up 60-264 months; median 84 months). All cases were reviewed by two authors (J.R.G., H.D.A.), who were blinded to clinical outcome and gross features, and classified as histologically benign or not benign using preset, defined histologic criteria based upon the authors' prior experience with a large number of these tumors. If the tumor did not fit with either the characteristic cellular spindle cell or benign epithelioid cell patterns, the tumor was classified as not benign. Clinical outcome was then correlated with the histologic designation to determine if these preset criteria were valid. The authors were able to accurately classify the tumors as benign or not benign with a sensitivity of 100% and a specificity of 92%. In addition, for all cases individual morphologic and clinical features were examined. Features associated with an AO included tumor size >/=7 cm, high cellularity, mucosal invasion, high nuclear grade, mitotic counts >/=5/50 high power fields, mixed cell type, and the presence of a myxoid background and/or absence of stromal hyalinization. By recognizing several well-defined patterns of benign gastric stromal tumors and the myriad of individual features shown to correlate with an AO, one can better predict the clinical behavior of gastric stromal tumors.     

胃肠道间质瘤46例临床诊治分析

目的探讨胃肠道间质瘤(G IST)的临床特点。方法对1998~2004年收治的46例G IST病人的临床表现、手术处理及病理结果进行回顾性分析。结果46例均行手术治疗。病理诊断良性13例(28.3%),潜在恶性10例(21.7%),恶性23例(50%)。随访时间6个月至6年,7例出现远处转移或局部复发,10例死亡(其中9例为恶性G IST)。结论G IST缺乏特征性临床表现,术前确诊率较低,其确诊依赖病理结果。目前G IST的治疗仍以手术切除为主,对复发或远处转移者积极再次手术可延长生存期。     

恶性胃肠道间质瘤CT影像特点研究

目的 从良恶性胃肠道间质瘤（GISTs）的CT影像学鉴别的角度出发,重点探讨恶性GISTs的影像学表现。方法 回顾性分析北京肿瘤医院2004-01-01至2006-10-31期间46例GISTs原发灶的CT影像表现,并行统计学分析,判断其对良恶性诊断的价值。结果 46例GISTs中,良性14例,恶性32例。两者在肿瘤大小、肿瘤边界情况、强化方式、并发溃疡、瘤周及瘤体内簇状或线状排列血管影显示等方面的差异具有统计学意义（P <0.05）。GISTs的生长方式、强化程度及有无钙化在良恶性鉴别上的差异无统计学意义（P >0.05）。结论 良性与恶性GISTs在CT影像表现上存在差异,恶性GISTs多表现为边缘不规则的较大肿块、不均匀强化、并发溃疡、瘤周及瘤体内簇状或线状排列的扩张血管影。在判断GISTs良恶性时要综合多方面的影像学表现进行分析。     

Risk factors for malignant evolution of gastrointestinal stromal tumors

Gastrointestinal stromal tumors are the most frequent non-epithelial digestive tumors, being classified in the group of primitive mesenchymal tumors of the digestive tract. These tumors have a non predictable evolution and where stratified regarding the risk for malignant behavior in 4 categories: very low risk, low risk, intermediate risk and high risk. We performed a retrospective non randomised study including the patients with gastrointestinal stromal tumors treated in the Department of General Surgery and Liver Transplantation of Fundeni Clinical Institute in the period January 2002 - June 2007, to define the epidemiological, clinico-paraclinical, histological and especially evolutive features of the gastrointestinal stromal tumors from this group, with a special regard to the risk factors for their malignant behavior. The most important risk factors in gastrointestinal stromal tumors are the tumor size and the mitotic index, based on them being realised the classification of Fletcher in the 4 risk categories mentioned above. In our group all the local advanced or metastatic gastrointestinal stromal tumors, regardless of their location, were classified in the group of high risk for the malignant behavior. The gastric location and the epithelioid type were positive prognostic factors, and the complete resection of the tumor, an other important positive prognostic feature, was possible in about 80% of the cases, probably because the gastrointestinal stromal tumors in our study were diagnosed in less advanced evolutive situations, only about one third being metastatic and about 14% being locally advanced at the time of diagnose. The association with other neoplasias was in our cases insignificant, only 5% of the patients presenting concomitant malignant digestive tumors and 7.6% intraabdominal benign tumors. Gastrointestinal stromal tumors remain a challenge for the medical staff, regarding their diagnose and therapeutical management, the stratification of the risk for their malignant behavior being essential for the evolution of these patients.     

����θ����������CTӰ���ص��о�

??Study of CT imaging in diagnosis of malignant gastrointestinal stromal tumors SUN Xue-feng*,ZHANG Xiao-peng,TANG Lei, et al. *Department of Radiology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing 100036, China Corresponding author: Zhang Xiao-peng, E-mail: zxp@bjcancer.org Abstract Objective To investigate the CT imaging features of malignant gastrointestinal stromal tumors (GISTs). Methods The morphologic characteristics of tumor were evaluated according to tumor size, shape, homogeneity, density compared with liver, contrast enhancement, presence of calcifications, ulcerations and the anatomical relationship to the intestinal wall, and the infiltration of adjacent visceral organs. Results Of the 46 patients with GISTs, 14 cases were classified as benign tumors, 32 cases as malignant tumors.There were differences in size,margin, enhancement pattern between benign and malignant tumors. Presence of ulcers or small vessels in /around the tumor arranged in clumps or in line was more frequently observed in primary malignant GISTs (P <0.05). No statistical differences of enhancement degree, growth pattern and presence of calcifications were observed between benign and malignant GISTs. Conclusion Malignant GISTs are typically large, with irregular margin and heterogeneous enhancement pattern. Presence of ulcers, and small vessels in/around the tumor which arranged in clumps or in line are more frequently observed in primary malignant GISTs. There are no differences in enhancement degree, growth pattern, and presence of the calcifications between benign and malignant GISTs.     

胃肠道间质瘤的CT表现与病理分级的相关性研究

目的对不同分级胃肠道间质瘤（GIST）的计算机断层扫描（CT）征象进行对比分析,评价CT表现对GIST病理分级的作用。方法收集有完整CT及病理组织学资料的原发性GIST共58例,其中恶性41例,良性和交界性者17例,对照病理组织学与病理分级,分析其CT征象对GIST分级的作用。结果发生于小肠、直肠的GIST比来源于胃和食道的恶性可能性更大。50例GIST表现为向腔外及壁间生长,其中38例为恶性;肿瘤平均最大径为7.5 cm,最大径≥7.5 cm者共26例,其中恶性23例;呈分叶状生长的GIST 35例,其中恶性30例。所有良性或交界性的GIST边界清晰,19例恶性GIST边界不清或部分不清。所有的恶性GIST均呈不均匀强化,均见坏死,10例良性或交界性者不均匀强化,亦可见坏死。15例恶性GIST出现周围侵犯。5例肝转移,1例腹膜种植转移。肿瘤明显强化、肿瘤表面血管、瘤内粗大血管、肿瘤腔侧面黏膜强化环及肿瘤腔侧面出现溃疡这几个因素在两组之间差异均无统计学意义。结论 CT检查对GIST的术前诊断和病理分级的评估有重要的意义。     

θ�������Լ��������ٴ�����

目的探讨胃肠道恶性间质瘤的临床诊断与治疗。方法回顾性分析1993～1999年22例胃肠道恶性间质瘤病人的临床资料。结果胃部肿瘤14例，小肠肿瘤8例。其中5例高度恶性，17例低度恶性1例广泛转移行肝结节活检，术后4个月死亡、4例行姑息切除，1例复发。其余行根治术，无病生存最长达5年。结论要提高对胃肠道恶性间质瘤的认识，加强免疫组化检查，确定良恶性及恶性程度，根治性手术对预后及防止复发有一定意义。     

胃镜及超声胃镜联合胸腹腔镜简捷微创切除上消化道良性肿瘤

目的探讨胃镜及超声胃镜联合胸腹腔镜简捷微创切除食道、胃、十二指肠上消化道直径〉2cm良性肿瘤方法的可行性及其临床价值。方法2005年06月至2009年02月,消化内科与腔镜外科、胸外科、麻醉科多科联合行微创手术,33例巨大广基良性肿瘤患者,在气管插管全身麻醉下,25例术中胃镜准确定位,超声胃镜确定病变的性质和深度,腹腔镜、胸腔镜行局部切除术。8例胃、十二指肠病例,由腹腔镜腔外保驾内镜行内镜下黏膜切除术或黏膜剥离术切除病变。结果胃镜＋胸腔镜行3例巨大固有肌层食管平滑肌瘤切除术,腹腔镜＋胃镜＋超声内镜行胃切除术23例,十二指肠切除术5例,联合手术均一次性成功,手术时间15～39min,术中出血量10～30ml,无中转开腹。术中内镜定位准确,术后病理证实均完整切除,切缘无残留,无吻合口瘘、切口感染或腹腔内感染等并发症发生。术后住院4～6d,随访6个月。5年,无复发。结论食管、胃、十二指肠巨大广基良性病变,通过胃镜、腹腔镜、胸腔镜联合手术,优势互补,提高腔镜手术中病变定位的准确率及手术的成功率,大大降低开腹率,是一种简捷、安全、有效的微创治疗方式,具有创伤小、恢复快等优点,有着良好的临床应用前景。