摘要
目的探讨小肠间质瘤(small intestinal stromal tumors,SIST)的临床特征和诊治方法。方法回顾性分析我院从2006年1月至2010年1月经病理组织学确诊的83例SIST患者的临床资料。结果 SIST的临床表现无特异性,最常见的表现:消化道出血55例(66.3%),贫血32例(38.6%),腹痛腹胀26例(31.3%)。SIST好发部位最常见依次为空肠、十二指肠、回肠,分别为40例(48.2%)、29例(34.9%)、13例(15.7%),另有空回肠交界1例(1.2%)。螺旋CT对SIST诊断率为100%(77/77),诊断符合率为72.7%(56/77),在各项检查中最为准确。83例患者均接受手术治疗,术后病理结果显示:极低度危险性16例(19.3%)、低度危险性24例(28.9%)、中度危险性17例(20.5%)、高度危险性26例(31.3%)。术后免疫组织化学CD117阳性率为95.2%(79/83),CD34阳性率为75.9%(63/83)。术后5例病灶完整切除并且病理极低度危险性患者未口服甲磺酸伊马替尼治疗,3年未见复发;其余78例患者均口服甲磺酸伊马替尼治疗,3年随访期内,短期服药组(≤2年)复发率为77.3%(34/44),1年、3年生存率分别为65.9%(29/44)、31.8%(14/44);长期服药组(>2年)的复发率为41.2%(14/34),1年、3年生存率分别为100%(34/34)、82.4%(28/34),两组相比较差异均有统计学意义(P<0.05)。结论 SIST临床表现无特异性,早期较难诊断,螺旋CT有较高的诊断价值,当前最主要的治疗方法是外科手术,术后长期服用甲磺酸伊马替尼可取得较好的远期疗效。
Objective To investigate small intestinal stromal tumors （SIST） of the clinical features, diagnosis and treatment. Methods A retrospective analysis of clinical data of 83 patients with pathologically confirmed SIST from Jan. ,2006 to Jan. ,2010 was performed. Results The clinical manifestations of SIST were non-specific,the most common manifestations：gastrointestinal bleeding in 55 cases （66.3%） ,anemia in 32 cases （38.6%） and abdominal pain in 26 cases （31.3%）. The most common predilection sites of SIST were jejunum, duodenum and ileum, respectively in 40 cases （48.2%） ,29 cases （34.9%） and 13 cases （15.7%） ,and both jejunum and ileum in 1 cases （1.2%）. Spiral CT in diagnosis rate of SIST was 100% （77/77） and diagnosis coincidence rate was 72.7% （56/ 77）, which was the most accurate in all the exaninations. All the 83 patients received operation therapy, postoperative pathological results： 16 cases （19.3%） of very low risk,24 cases （28.9%） of low risk, 17 cases （20.5%） of moderate risk and 26 cases （31.3%） of high risk. The positive rate ofpostoperative immunohistochemical CD117 was 95.2 % （79/83）, while the positive rate of CD34 was 75.9 % （63/83）. After the operation,5 cases of pathology of extremely low risk were completely resected without oral treatment with imatinib mesylate,and they sarvived in 3 years without recurrence; the other 78 patients were in oral imatinib mesylate treatment, and followed up for 3 years, the recurrence rate of short-term treatment group （42 years） was 77.3% （34/44）, 1- and 3-year survival rates were 65.9% （29/44） and 31.8% （14/44） ;the recurrence rate of long-term medication group （〉2 years） was 41.2% （14/34） ,1- and 3-year survival rates were 100% （34/34） and 82.4% （28/34） ,the difference between the two groups were significantly different （P〈0.05）. Conclusions The clinical manifestations of SIST are non-specific,and its early diagnosis is difficult. However, spiral CT has high value in disgnosis of SIST. The surgical operation treatment is the main method of treatment,long-time oral imatinib mesylate medication after the operation can obtain better long-term efficacy.
出处
《复旦学报（医学版）》
CAS
CSCD
北大核心
2013年第6期729-732,751,共5页
Fudan University Journal of Medical Sciences
关键词
小肠间质瘤(SIST)
诊断
治疗
small intestinal stromal tumor （SIST）
diagnosis
treatment
