空肠回肠间质瘤的诊断和治疗

目的 探讨空肠回肠间质瘤诊断和治疗经验。方法 对我院1993～2003年收治的有完整资料经术后病理和免疫组化证实的15例空肠回肠间质瘤病例进行回顾性分析。结果 本组病人主要临床表现为黑便、腹痛、头晕、乏力。术前选择性血管造影发现小肠出血2例、核素扫描发现小肠出血1例。剖腹探查确诊7例,腹腔镜腹腔探查确诊4例,术前明确诊断的仅1例。发病至确诊时间2月～7年。14例病人行间质瘤切除、小肠吻合术,1例肿瘤无法切除的病人行口服Gleevec保守治疗。随访2月～9年,除1例病人死于其它疾患,1例在继续服用格列卫治疗外,余13例病人均健在,空肠回肠问质瘤无复发。结论 空肠回肠间质瘤缺乏特征性临床表现及有效诊断手段,易致长期延误诊治。对长期不明原因的消化道出血病人及早行剖腹探查或腹腔镜腹腔探查是避免空肠回肠间质瘤长期延误诊治、改善病人预后的关键。

Diagnose and treatment of stromal tumor of jejunum or ileum

Objective To summarize the experience in the diagnosis and treatment of stromal tumor of jejunum and ileum. Methods Fifteen patients were retrospectively reviewed with stromal tumor of jejunum or ileum confirmed by pathology post operation in our department from Oct. 1993 to Oct. 2003. Results The major clinical signs of stromal tumor of jejunum or ileum included: digestive duct hemorrhage, abdomen pain, dizziness hypodynamia and melena. Hemorrhage site of small intestine were determined by digital subtraction angiography in 2 cases, by radionuclide imaging in 1 case. In this group, 7 cases were diagnosed by exploratory laparotomy for melena, 4 cases diagnosed by laparoscopic laparotomy for melena, one case diagnosed by exploratory laparotomy for hepatic cyst. Only one case was diagnosed by small intestine endoscopy before operation. The period of patients having clinical symptom before operation was from 2 mouths to 7 years. Fourteen patients were subjected to part bowel resection including small bowel stromal tumor and small bowel to small bowel anastomosis. One patient was treated by Gleevec for jejunal stromal tumor not to be excised. During a follow-up from 1 mouth to 9 years, 13 patients survived today except one case died of other disease, and one cases had been treated by Gleevec. No recurrence of stromal tumor of jejunum or ileum occurred in this group. Conclusion Stromal tumor of jejunum or ileum is lack of special clinical symptoms, signs and effective examination methods, so it is difficult to diagnose early. Digital subtraction angiography and radionuclide imaging are helpful to diagnose this disease. Exploratory or laparoscopic laparotomy is first choice for these patients with suspicious stromal tumor of jejunum and ileum.