直肠间质瘤的诊断和治疗

目的探讨直肠间质瘤的临床诊断和治疗。方法回顾性分析北京大学临床肿瘤学院1998年10月至2006年2月收治的8例直肠间质瘤的临床表现、病理及治疗。结果直肠问质瘤的临床表现与肿瘤大小相关，主要包括便次增多、排尿困难、血便及肛门疼痛等。病变部位均位于低位直肠且病灶常常较大。8例均经病理确诊为直肠间质瘤，免疫组化CD117（＋）7例，CD34（＋）8例。2例行格列卫（伊马替尼）术前辅助治疗，结果症状明显缓解，肿物较前缩小。7例行手术完整切除（5例行Miles术，2例行经肛门肿瘤局部切除术）。结论直肠间质瘤引起症状时常已较大，确诊需病理形态学及免疫组化证实。对于低位直肠且病灶较大的直肠间质瘤病人，宜行腹会阴部切口将肿瘤完整切除，格列卫术前辅助治疗可能会提高肿物完整切除率。

Diagnosis and treatment of rectal stromal tumors

Objective To analyze the features of clinical diagnosis and treatment of rectal stromal tumors.Methods Clinical and pathological data and treatment of 8 cases of rectal stromal tumors admitted between October 1998 and February 2006 in Peking University School of Oncology were analyzed retrospectively.Results Presentations and symptoms of rectal stromal tumors varied depending on the tumor size.The most common clinical presentations were increased frequency of defecation,urinary retention,bloody stool and anal pain.Lesions located at low rectum and the size was usually larger.Rectal stromal tumors were diagnosed by pathology in all cases.Immunohistochemical results showed that CD117(+) in 7 cases and CD34(+) in 8 cases.Two cases accepted imatinib mesylate (Glivec) before operation.Symptoms of patients alleviated significantly.Size of tumors decreased significantly. Seven of the 8 cases underwent surgical resection.Among them,5 cases were treated by abdominoperineal resection and 2 cases were resected transanally.Conclusion Size of rectal stromal tumors is usually larger when the symptoms appear.Diagnosis of the disease depends on pathological result.Abdominoperineal resection is a reasonable choice for low rectal stromal tumors with large lesions.Neoadjuvant therapy of imatinib mesylate before operation may be benefit for complete surgical resection.