胃肠道间质瘤的临床诊断与治疗_医学论文.docVIP

胃肠道间质瘤的临床诊断与治疗_医学论文 胃肠道间质瘤的临床诊断与治疗_医学论文 作者：王海波 周岩冰 兰军良 周宽德 孙明辉 　　［摘要］目的 探讨胃肠道间质瘤（GIST）的临床诊断和治疗方法。方法 收集我院31例手术治疗的GIST病人的临床资料，对其病理、临床诊断和治疗方法进行分析。结果 本组病人平均发病年龄为52.3岁。男女发病无明显差异。本病临床表现无特异性，但临床常以消化道出血、疼痛多见。消化内镜、B超、CT等检查可发现肿瘤，免疫标记物CD34、CD117在GIST中有较高表达，通过病理组织学及免疫组化检查可明确诊断。本组病人均行手术治疗。结论GIST病人术前消化道症状无特异性 ，明确诊断较困难，CT检查因其具有分辨力高、组织对比好的优势，对间质瘤的定位诊断有重要作用。手术切除肿瘤为主要治疗方法，术后放、化疗的效果难以肯定，靶向治疗前景乐观。 　　［关键词］ 莱迪希细胞瘤诊断治疗结果 　　［ABSTRACT］ObjectiveTo study the clinical diagnosis and treatment of gastrointestinal stromal tumor （GIST）. Me- thodsThe clinical data which included pathology， diagnosis and treatment of 33 patients with GIST were analyzed. Results The average age of onset was 52.3 without great sex differences. No specificity in manifestations was noted in this disease， but gas-trointestinal hemorrhage and/or pain were commonly seen. Tumors could be detected by digestive endoscopy， CT， or ultrasonogra-phy. The immunological markers CD34 and CD117 were highly expressed in GISTs . The diagnosis could be confirmed by histology and immunohistollogy. All the patients in this study were treated surgically. ConclusionMaking a definite diagnosis of GIST be-fore operation is usually difficult as lack of specific digestive symptoms. CT scan plays an important role in tumor localization as it has a high resolution power and better tissue contrast. Resection of the tumors is the main treatment for this disease. The effects of post-operative radiotherapy and chemotherapy are uncertain. The outlook of targeted therapy will be optimistic. 　　［KEY WORDS］leydig cell tumor diagnosis treatment outcome 　　胃肠道间质瘤（GIST）是一组起源于胃肠道肌层的间叶性肿瘤，传统上大多将它诊断为平滑肌源性或神经源性肿瘤。近年来的研究表明，此类肿瘤并不同于真正的平滑肌瘤和神经源性肿瘤，而是一种非定向分化的间质细胞肿瘤。我院自2000年1月～2005年3月收治了31例GIST病人，为进一步提高对GIST的认识，现就其临床诊断、治疗等回顾分析如下。 　　1 资料与方法 　　1.1 一般资料 我院共手术治疗并经病理及免疫组化染色确诊GIST病人31例，男17例，女14例年龄30～75岁，平均52.3岁。病变位于胃18例，空肠5例，回肠4例，结肠3例，直肠1例，其中胃间质瘤致肝转 移2例。 　　1.2 方法 　　1.2.1术前诊断方法 本组31例均行B超或CT检查。18例胃间质瘤术前均行内镜检查，13例行X线钡餐造影。9例小肠间质瘤中，行X线全消化道钡餐造影者7例。3例结肠间质瘤及1例直肠间质瘤均行纤维结肠镜检