胃肠道间质瘤诊治体会.docVIP

胃肠道间质瘤诊治体会 　　【摘要】 目的 提高胃肠道间质瘤(GIST)的诊治水平。方法 分析近10年来我院收治的36名GIST患者,总结GIST的诊治结果。结果 36例均经手术及病理确诊,肿瘤位于胃17例,小肠9例,结直肠10例。19 例完整切除,6例姑息切除,1例仅行活检术;联合脏器切除6例。结论 GIST是一类具有恶性倾向的肿瘤。生物学行为多变。手术是唯一能治愈的方法,配合伊马替尼(格列卫)治疗可得到满意的疗效。 　　【关键词】 胃肠道间质瘤;伊马替尼(格列卫);分子靶向 　　The diagnoses and treatment of Gastrointestinal Stromal Tumors:a report of 36 cases 　　ZHOU Yi,LIU Hui.Department of General Surgery,Affiliated MiDong Hospital People,sHospital of XinJiang Uygur Autonomous Region,Urumqi 830021,China 　　【Abstract】 Objective To discuss the clinicaopathological characteristics,diagnoses and treatment of extragastrointestinal stromal tumors(GIST).Methods The clinical and pathological data and treatment of 36 cases from January 1997 to January 2007 were analyzed retrospectively.Results All the cases diagnosed by surgery and pathology in all the cases,17 cases arose from stomach,9 cases from small intestine and 11 cases from coloretum.36 cases underwent surgical treatment,of all 20 caseswere resected completely,6 cases were resected palliatively,biopsy was performed in 1 case and combined organ resection was performed in 6 cases.Conclusion GIST has a low p revalence clinically,the biological behaviour is changeable,.Surgical resection is the only curablemethod,and gleevec perhaps has the effect to prevent tumor recurrence. 　　【Key words】 Gastrointestinal strornal tumors; Imatinib; Sunitinib 　　 　　胃肠道间质瘤(gastrointestinal stromaI tumor GIST)在过去多被误诊为平滑肌瘤或神经性肿瘤,目前公认的定义为发生于胃肠道的c-kit阳性的间叶性肿瘤(包括平滑肌来源或神经胚层来源)。在组织学上GIST有良恶性的区别,但多数学者认为GIST 多少具有恶性倾向,这一观点使我们对于GIST有了全新的认识。本次研究,总结回顾了我院近10年来GIST的诊治进展,希望可以提高对于GIST的诊治水平。 　　1 临床资料 　　1.1 一般资料 我院自1999年7月至2009年7月共临床收治GIST 36例,其中男23例,占63.8%,女13例,占 36.2%:年龄分布,最小26岁,最大72岁,中位年龄45岁。 　　1.2 诊断标准 根据Franque mont和Appel man对于GIST的诊断标准纳入本次研究病例,其中恶性病例9例,占25%;良性病例l6例,44.5%;具有恶性潜性或处于交界性肿瘤1l例,占30.5%。 　　1.3 术前诊断 以消化道出血为首发症状入院的l3例,占36.1%;以腹部包块入院的ll例,占30.6%。腹部不适入院8例,占22.2%。以肠梗阻入院2例,占5.6%(见表1)。病程最长5年,病程最短7 d,其中3例因包块压迫出现不同程度的输尿管扩张,肾盂积水;2例因包块压迫横结肠或乙状结肠出现不全性肠梗阻。术前B超、CT、胃镜以及消化道钡餐透视均对诊断