96例胃肠道间质瘤临床诊治分析

目的　探讨胃肠道间质瘤的病理诊断、外科治疗及预后相关因素。方法　回顾分析 96例经手术治疗的胃肠道间质瘤患者的临床病理资料 ;免疫组织化学方法检测CD117、CD34、平滑肌肌动蛋白 (SMA)和S 10 0的表达情况。结果　免疫组织化学阳性表达率CD117为 79.2 % (76 / 96 )、CD34为 5 8.3% (5 6 / 96 )、SMA为 35 .4 % (34/ 96 )、S 10 0为 9.4 % (9/ 96 )。良性 2 3例 ,恶性 73例。恶性组病例中 ,首次手术中切除大网膜 39例 ,未切除大网膜 34例 ,转移复发率分别为 5 .1%和 2 6 .5 % (P <0 .0 5 ) ;手术切除肠管断端距肿瘤 >5cm 4 6例 ,≤ 5cm 2 7例 ,转移复发率分别为 6 .5 %和 2 9.6 % (P <0 .0 5 )。良、恶性胃肠道间质瘤 5年生存率分别为 91.5 %和 5 7.3%。结论　CD117及CD34等免疫标记物配合使用可以提高胃肠道间质瘤的病理诊断准确率。采用合理的首次手术治疗及大网膜预防性切除可减少胃肠道间质瘤的复发。

Diagnosis and treatment of gastrointestinal stromal tumors: a study of 96 patients

Objective To investigate the pathological diagnosis,surgical treatm ent and prognostic factors of gastrointestinal stromal tumors (GISTs). Methods The clinicopathological data of operated 96 patients with GISTs were analyzed r etrospectively. Expression of CD117,CD34,SMA and S-100 was determined by immu nohistochemical methods. Results Expression of CD117,CD34,SMA and S-100 was 7 9.2%(76/96),58.3%(56/96),35.4%(34/96) and 9.4%(9/96). Benign tumor 23 a n d malignant 73. Of the malignant,the omentum was resected in 39 and the rest re mained,of which the recurrent and metastatic rates were 5.1% and 26.5% ( P <0.0 5). The safety margin between the normal intestine and tumor was >5 cm in 46 pat i ents;while in the other 27 patients,it was <5 cm. The recurrent and metastatic rates were 6.5% and 29.6%( P <0.05),respectively. The 5-year survival r ates of benign and malignant GISTs were 91.5% and 57.3% ( P <0.05). Conclusion The appl ication of immunohistochemical markers CD117 and CD34 are supplementary to pat hol ogical diagnosis. The adapting of rational primary treatment,including complete tumor resection and prophylactic omentectomy,is able to reduce the recurrence of GISTs.