33例胃肠间质瘤临床诊治分析

目的探讨胃肠间质瘤（GIST）的临床表现、诊断与外科治疗方法。方法回顾性分析33例GIST患者的临床表现,CT、胃肠镜、超声内镜（EUS）等辅助检查资料,免疫组化诊断及外科手术治疗的结果。结果 33例患者临床表现为不同程度的上消化道出血、腹痛、腹胀、腹部包块等。均行手术治疗,肿瘤位于胃24例,十二指肠1例,小肠6例,直肠2例;术后病理诊断9例危险程度为极低度,7例危险程度为低度,8例危险程度为中度,9例危险程度为高度;免疫组化以CD117、CD34阳性率较高,分别为90.9%,87.9%。结论 GIST临床症状无特异性,术前诊断困难,确诊依赖于病理检查及免疫组化,外科手术治疗是首选方法,分子靶向治疗可缓解肿瘤复发,改善预后。

A clinical diagnosis and treatment of 33 patients with gastrointestinal stromal tumors

Aims To investigate the value of symptoms,signs,different clinical diagnosis methods,and the outcome of surgical managements for patients with gastrointestinal stromal tumors(GIST).Methods A retrospective study of the clinical data of 33 patients with surgically and pathologically proved GIST was done.The data mainly included the symptoms and signs,abdominal CT,abdominal ulrasonography,upper or lower endoscopy and endoscopic ulrasonography(EUS).Results Of 33 cases,the clinical manifestation was the upper gastrointestinal bleeding,abdominal pain,abdominal distention and abdominal mass.GISTs were found in stomach in 24 patients,in duodenum in 1 patient,in small intestine in 6 patients,and in rectum in 2 patients.With malignant degree,9 patients were very low grade,7 patients were low grade,8 patients were moderate grade,and 9 patients were high malignant grade.The positive rates for CD117 and CD34 were 90.9% and 87.9% respectively.Conclusion The clinical symptoms and signs were not specific in GIST.Definite preoperative diagnosis is hard to get.Diagnosis depends on the pathological examination and immunohistochemistry.Surgical treatment is first selection method,molecular targeted therapy can alleviate tumor recurrence and improve the prognosis.