胃肠道间质瘤56例临床诊治分析.DOCVIP

临床医学论文-胃肠道间质瘤56例临床诊治分析 ?????? 作者：邓量，王钟兴，彭志刚，甄宇洋 ［摘要］? 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56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-100的表达情况。结果? 免疫组织化学阳性表达率CD117为71.4%(40/56)、CD34为57.1%(32/56)、SMA为32.1%(18/56)、S-100为8.9%(5/56)。良性10例,恶性46例。恶性组病例中,首次手术中切除大网膜22例,未切除大网膜24例,转移复发率分别为4.5%和20.8%(P0.05)；手术切除肠管断端距肿瘤5 cm 30例,≤5 cm 16例,转移复发率分别为6.7%和18.8%(P0.05)。良、恶性胃肠道间质瘤5年生存率分别为92.3%和57.4%。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。 ??? ［关键词］? 胃肠肿瘤；间质瘤；肿瘤复发；CD117；CD34 ??? Diagnosis and treatment of gastrointestinal stromal tumors:a study of 56 patients ??? ［Abstract］? Objective? To investigate the pathological diagnosis,surgical treatment and prognostic factors of gastrointestinal stromal tumors (GISTs).Methods? The clinicopathological data of operated 96 patients with GISTs were analyzed retrospectively.Expression of CD117,CD34,S-100 was determined by immunohistochemical methods.Results?Expression of CD117,CD34,SMA and S-100 was 71.4%(40/ 56),57.1%(32/56),32.1%(18/56) and 8.9%(5/56).Benign tumor 10 and malignant 46,of the malignant,the omentum was resected in 22 and the rest remained,of which the recurrent and metastatic rates were 4.5% and 20.8% (P0.05).The safety margin between the normal intestine and tumor was 5 cm in 30 patients;while in the other 16 patients,it was ≤5 cm.The recurrent and metastatic rates were 6.7% and 18.8%(P0.05),respectively.The 5-year survival rates of benign and malignant GISTs were 912.3% and 57.4% (P0.05).Conclusion? The application of immunohistochemical markers CD117 and CD34 are supplementary to pathological diagnosis.The adapting of rational primary treatment,including complete tumor resection and prophylactic omentectomy,is able to reduce the recurrence of GISTs. ??? ［Key words］? gastrointestinal neoplasms;stromal tumors;tumor recurrence;CD117;CD34 ??? 胃肠道间质瘤(gastrointestinal stromal tumors,GIST)是发生于消化道的一种少见的肿瘤,过去由于病理诊断技术手段的限制,加上在肿瘤组织中残存有平滑肌或神经束,常被误诊为平滑肌瘤或神经源性肿瘤。鉴于其特殊的组织学、免疫表型及分子遗传学的特点,M