小肠间质瘤临床诊断和治疗

目的探讨小肠间质瘤(GIST)的诊断和治疗。方法对我院1999年1月~2004年4月收治的16例小肠GIST患者的临床表现、手术处理及病理结果进行回顾性分析。结果全组平均发病年龄53岁。发病至就诊时间为半个月至5年不等。首诊主要表现为黑便、腹部不适、腹部肿块,发生部位为空肠5例,回肠8例,空、回肠均有3例。术前5例行DSA检查,诊断小肠肿瘤4例;11例行CT检查,均发现腹腔占位,诊断小肠肿瘤7例;全消化道造影检查8例,发现小肠受压2例。均行手术治疗,其中4例在腹腔镜下完成。手术标本均经病理及免疫组化证实。12例随访时间6个月至5年,平均随访27.3个月,4例失访。其中根治性切除9例,复发2例,均再次手术,仍健在;腹腔镜下小肠肠段切除术4例均无复发。结论小肠GIST缺乏特征性临床表现,DSA检查和CT检查对诊断有一定帮助,但术前确诊率较低,其确诊依赖病理结果。目前小肠GIST的治疗仍以手术切除为主,对复发或远处转移者应积极再次手术,可延长生存期。

Diagnosis and treatment of stromal tumor of small intestine

Objective:To investigate the experience in the diagnosis and treatment of stromal tumor of small intestine.Methods:Sixteen patients were retrospectively reviewed with stromal tumor of small intestine in our unit from Jan. 1999 to Apr.2004.Results:The average age of patients in this group was 53. The period of patients having clinical symptom before operation was from half a month to 5 years. The major clinical signs of stromal tumor of small intestine included: melena,abdomen pain and abdomen mass. In this group,5 cases occurred in jejunum,8 caeses in ileum,and 3 cases in both jejunum and ileum. Digital subtraction angiogragh(DSA) was performed in 5cases,4 cases were diagnosed; CT was performed in 11 cases,positive findings were detected in all cases and 7 cases were diagnosed; Gastrointestinal graph was performed in 8 cases,2 cases were detected positive findings. All cases were operated and 4 cases were operated by laparoscopy. The specimens were confirmed by pathology and immunohistochemistry. 12 cases were followed-up from 2 months to 5 years. 9 patients with radical operation survive.Among them,2 patients with recurrence had been re-operated. 4 cases with laparoscopic intestinal segment resection had not been found recurrence.Conclusion:Stromal tumor of small intestine lacks special clinical symptom,sign and effective examination methods,DSA or CT is helpful to diagnosis to a certain. Last diagnosis depends on pathologic examination. Laparoscopic or exploratory iaparotomy is the first choice for these patients with suspicious stromal tumor of intestine. Cases with recurrence should be re-operated.