24例胃肠道间质瘤临床诊治分析

目的探讨胃肠道间质瘤（GIST）的临床特点、诊断和治疗方法,进一步提升此类疾病的诊治水平。方法对黄山市人民医院2010年3月—2013年9月收治的24例GIST患者的临床和病理资料进行回顾性分析（这些患者都接受了手术治疗,并且术后病理检查和免疫组化证实为GIST）。结果最常见的临床表现为腹部不适,占50.0%（12/24）;其次为消化道出血,占20.8%（5/24）;腹部肿物,占20.8%（5/24）;2例患者无明显症状,占8.3%。全部病例中,CT检查均提示占位性病变,肿瘤体积越大,恶性的可能性越大,差异有统计学意义（P〈0.05）;CT显示肿瘤的外形越不规则,越表现为恶性,差异有统计学意义（P〈0.05）。手术切除标本瘤体所在部位与肿瘤良恶性差异无统计学意义（P〉0.05）,瘤体大小与肿瘤良恶性差异有统计学意义（P〈0.05）。免疫组化CD117阳性率100.0%（24/24）、CD34阳性率95.8%（23/24）。结论 GIST无特异性的临床表现,多层螺旋CT检查对该病诊断有重要的意义。GIST的确诊还是需要病理检查和免疫组化检查的结果。CD117是GIST最重要的标记物。手术完整切除肿瘤是GIST的首选治疗方式,靶向治疗药物伊马替尼可改善预后。

Analysis of clinical diagnosis and treatment of 24 cases of gastrointestinal stromal tumors

Objective To explore the clinical features,diagnosis,treatment and prognosis of the gastrointestinal stromal tumor（GIST）and improve the level on diagnosis and treatment of this disease. Methods The clinical and pathological data of 24 patients with GIST in our Hospital from March 2010 to September 2013 were retrospectively analyzed. All of these patients had undergone surgical treatment and confirmed by histopathologic examination and immunohistochemistry.Results The most common primary symptom was abdominal discomfort accounting for 50. 0%（12 /24）,followed by gastrointestinal tract hemorrhage for 20. 8%（5 /24）,abdominal mass for 20. 8%（5 /24）;2 cases had no symptoms that accounted for 8. 3%. All of the cases were with the space occupying lesion on CT. The possibility of malignancy raised with the size of the tumors,there was a significant difference（P〈0. 05）;the irregular shape on CT also raised the possibility of malignancy,the difference was significant（ P〈0. 05）. The location of tumors had no relationship with the malignancy（P〈0.05）,but the size of tumors had relationship with the malignancy（P〈0.05）. All of 24 cases were with positive CD117 by immunohistochemistry,accounting for 100 percent;23 cases were with positive CD34,accounting for 95. 8 percent. Conclusion GIST has no specific characteristics in clinical features. MSCT plays an extraordinarily role in the diagnosis of GIST. The confirmation of GIST required also the histopathologic examination and immunohistochemistry.CD117 is the most important marker of GIST. The surgery treatment is the first choice for the GIST,while the molecular targeting treatment with Imatinib will improve the prognosis of the patients.