胃恶性间质瘤的诊断与治疗

目的:探讨胃恶性间质瘤的术前诊断方法及有效的治疗手段。方法:回顾性分析我院1995年~2005年间收治的9例胃恶性间质瘤患者的临床表现、理化检查、治疗方法及结果。结果:胃恶性间质瘤患者多表现为反复的消化道出血、腹痛、腹部不适及腹部包块,纤维胃镜、超声内镜、消化道钡透、腹部CT检查有助于手术前诊断。本组患者肿瘤最大直径为5.5cm~21cm,平均为11.8cm,根治性手术7例、姑息性减瘤手术2例,根治性手术患者中2例术后复发接受二次手术,4例无瘤生存5年以上,姑息性手术2例患者均于术后6个月内死亡。免疫组化检查CD117阳性9例(100%)、CD34阳性7例(77.8%)、Vimentin阳性7例(77.8%)S-100阳性5例(55.6%),Actin阳性4例(44.5%)。结论:免疫组化检查可确诊胃恶性间质瘤,根治性手术减少手术后复发及远处转移。

The diagnosis and treatment of malignant gastric stromal tumors

Objective:To investigate diagnosis methods and effective treatment for malignant gastric stromal tumors. Methods: A retrospective review on 9 patients with malignant gastric stromal tumors who underwent treatment in our hospital from 1995 to 2005,Clinical findings, outcomes of physical and chemical examination, managements and outcomes of treatment have been analyzed. Results: The patients with malignant gastric stromal tumors often accompany with gastrointestinal bleeding, abdominal pain and abdominal mass. Preoperative gastroscopic, endoscopic ultrasound (EUS), computed tomography (CT) and barium examinations can help diagnosis.The tumor bigest diameter was from 5.5cm to 21cm and average diameter of tumor was 11.8cm, radical resection was performed on 7 cases and 2 cases underwent palliative resection,2 cases who underwent radical resection accepted reoperation for recurrence,2 cases who underwent palliative resection died in 6 months .Immunohistochemical staining showed CD117 positive in 9 cases (100),CD34 positive 7 cases(77.8),Vimentin positive 7 cases(77.8) S-100 positive 5 cases(55.6), Actin positive 4 cases(44.5).Conclusion: Antigen marker, such as CD117,CD34,Vimentin ,S-100 and Actin can be used to diagnose malignant gastric stromal tumors, radical resection can reduce the change of recurrence and metastasis.