小肠间质瘤致急性消化道大出血22例临床分析

目的 总结并发急性消化道大出血的小肠间质瘤的临床特点和诊治方法.方法 对近5年来合并急性消化道大出血的22例小肠间质瘤患者的临床和病理资料进行回顾性分析.结果 22例均行肿瘤完整性切除,18例于切除肿瘤后行温热蒸馏水浸泡腹腔.术后1例死于多脏器功能衰竭,余21例均治愈出院.随访2～ 73个月,失访2例.出现肝转移2例,腹腔复发4例(1例死亡,3例仍存活).结论 合并急性消化道大出血的小肠间质瘤瘤体巨大,具有高度恶性危险度和易发生腹腔种植和肝脏转移的特点.诊断首选DSA检查,不但可以早期诊断出血原因,同时可以确定病变位置.以完整的外科手术切除为主的综合治疗是小肠间质瘤合并急性消化道大出血的最佳治疗方法.

Clinical analysis of acute massive alimentary tract bleeding caused by intestinal stromal tumor: a report of 22 cases

Objective To summarize the clinical characteristics,diagnosis and treatment of acute massive aimentary tract bleeding caused by intestinal stromal tumor.Methods The clinical and pathological manifestation of 22 patients diagnosed as intestinal stromal tumor complicated with acute massive alimentary tract bleeding during the past 5 years were analyzed retrospectively.Results All the 22 patients were in the high-risk category according to the Fletcher grading standards and received complete resection of the tumor,among which 18 received celiac immersion with warm distilled water after the removal of the tumor.One patient died of postoperational multiple organ failure,and 21 patients were cured.Patients were followed up for 2 months to 73 months,with 2 cases dropout.Hepatic metastases and peritoneal recurrence were detected in 2 cases and 4 cases respectively(1 case died,3 cases survived).Conclusion Intestinal stromal tumors complicated with acute gastrointestinal bleeding share some similar features,such as huge in size,high-risk malignant and high risk to peritoneal recurrence or hepatic metastases.DSA is one of the best methods of diagnosis,which not only help confirm the reason for bleeding at early stage,but also help locate the lesion.Comprehensive treatment based on surgery was the best therapy for intestinal stromal tumor combined with acute massive gastrointestinal bleeding.