胃肠道间质瘤的诊治策略（附51例分析）

目的：研究胃肠道间质瘤的临床特点、诊断、治疗方法及预后。方法：对2003年～2008年在吉林大学第一医院经病理诊断的所有胃肠道间质瘤患者进行回顾性分析。结果：51例确诊为胃肠道间质瘤患者中，胃、小肠和结直肠分别为49．0％、39．2％、11．8％。70％患者有临床症状，常见症状为消化道出血、腹痛、消瘦等。免疫组化CD117、CD34阳性率分别为90．2％、58．8％，二者同时表达54．9％。手术完全切除率68．6％，姑息切除率29．4％，切除18枚淋巴结，均无转移。极低度及低度危险性患者术后无复发转移及死亡，中、高度危险性患者复发、转移率61．8％。对于复发或转移的患者，格列卫治疗差异有统计学意义。肿瘤原发部位、大小、核分裂相和组织学类型在生存的单因素分析中起着预示性的作用。结论：胃肠道间质瘤的临床特点不同于其他消化道肿瘤，诊断依赖于病理及免疫组化，CD117和CD34对其诊断较重要。胃肠道间质瘤首选治疗方法是手术切除，不主张行常规标准淋巴结清扫。肿瘤原发部位、大小、核分裂相和组织学类型是评估其预后及危险性的重要因素，对于转移或不能切除者，格列卫是目前最有效的治疗方法。

The strategy of diagnosis and treatment of gastrointestinal stromal tumors:Analysis of 51 cases

Objective To study the clinical character,diagnosis,treatment and prognosis of gastrointestinal stromal tumors(GIST).Method Allcases of GIST in First Hospital of Jilin University diagnosed between 2003 and 2007 were analyzed retrospectively to evaluate their clinical findings.Results There were totally 51 cases with GIST.49.0% of them had the stromal tumors in stomach,39.2% in the small intestine,and 11.8% in Colorect.70% of them had symptoms,including gastrointestinal bleeding,abdominal pain and weight loss.CD117 and CD34 positive rate with immunohistochemical detection were 90.2% and 58.8%,CD117 and CD34 were both positive in 54.9%.The total resection rate was 68.6%,and palliative resection rate was 29.4%.All of the 18 lymph nodes resected from the 51 patients were free from tumor metastasis.None of the patients in the low-risk group had recurrence or distant metastasis.The rate of recurrence and metastasis in the moderate-risk or high-risk group was 61.8% after operation.For recurrent or metastatic patients,treatment with Gleeve was better than those didn't receive Gleeve.Primary organ of tumor,tumor size,mitotic rate,and histologic type had prognostic value inunivariate analysis.Conclusion The clinical characteristics of GISTs are different from that of other common gastrointestinal cancers.Diagnosis is rely on pathology and immunohischemistry,and CD117 is very important.Surgical resection of the primary tumor is the standard treatment for GIST.Elimination of lymph nodes regularly isn't recommonded.Primary organ of tumor,tumor size,mitotic rate,and histologic type are important factors correlated with the prognosis and risk scores.Gleeve is the most effective systemic therapy for patients with metastatic or unresectable GIST.