小肠间质瘤的诊治  

The diagnoses and treatment of small intestinal stromal tumor

作　　者：罗壮[1] 廖秀军[2] 孟荣贵[3] 于恩达[3] 张卫[3] 傅传刚[3] 

机构地区：[1]江苏省淮安市中医院肛肠外科,江苏淮安223001 [2]浙江省杭州市第三人民医院肛肠外科,浙江杭州310009 [3]第二军医大学附属长海医院肛肠外科,上海200433

出　　处：《中国普通外科杂志》2008年第10期970-973,共4页China Journal of General Surgery

摘　　要：目的探讨小肠间质瘤的诊断和治疗方法。方法回顾性分析32例空回肠间质瘤患者的临床资料。结果32例患者平均发病年龄52.8岁,病程10h至5年。主要临床表现为黑便、腹痛、腹部肿块、腹胀不适、发热、乏力、贫血、体重下降等。发生部位:空肠26例,回肠5例,空回肠多原发性1例。B超检查12例提示腹腔肿块,其中4例提示来源于肠道,5例不能提示来源,3例误诊为卵巢肿瘤。4例行消化道造影,均阴性。20例行CT检查,均发现肿瘤或转移病灶,阳性发现率100%,其中15例定位于肠道肿瘤(75.0%)。8例行数字减影血管造影(DSA),6例提示小肠肿瘤。5例行小肠镜检查,均明确诊断小肠肿瘤。所有患者均手术治疗。术后经病理及免疫组化证实为间质瘤。4例肝转移患者口服格列卫治疗。22例获得0.5～5年的随访,术后复发4例,肝转移2例,死亡2例。结论空回肠间质瘤缺乏特征性临床表现,CT和DSA对诊断有帮助,小肠镜诊断率高,手术及分子靶向治疗是其有效治疗方式。Objective To study the diagnosis and treatment of small intestinal stromal tumor （SIST）. Methods We retrospectively analysed the clinical information of 32 patients with SIST. Results The average onset age of the patients was 52. 8 years. The main clinical manifestations were dark stools, abdominal pain, abdominal mass, abdominal distention, fever, debilitation, anaemia, and loss of body weight. The tumors were located in jejunum in 26 cases, in ileum in 5 cases, and 1 patient had multiple tumors in both jejunum and ileum. The abdominal mass was discovered by B-ultrasonography in 12 patients. Among the 12 cases, 4 cases were diagnosed with the tumor located in intestinal tract, in 5 cases the origin of the tumor could not be determined, and 3 cases were misdiagnosed as tumor of the ovary. Tweenty patients who received CT scan were all discovered to have primary tumors or metastatic lesions.. The CT positive detection rate was 100% , and 15 of the tumors were confirmed to be located in intestinal tract （75%）. In 6 of g patients, the intestinal tumors were discovered by digital subtraction angiography （ DSA ） ; 5 patients were diagnosed with intestinal tumor by small intestinal endoscopy. There were no positive findings in the 4 patients who received radiographic studies of digestive tract. All patients received surgical operation. Their diagnosis was confimed as stromal tumor by pathology and immunohistochemistry. Tweenty-two patients were followed up from 6 months to 5 years, 4 patients had recurrence, 2 hepatic metastasis, and 2 died. Conclusions The stromal tumor of jejunoileum lacks distinctive clinical manifestations, CT and DSA can be of benefit in diagnosis, and small intestinal endoscopy is an effective way for diagnosis. Operation and. molecular targeted therapy are effective treatment of SIST.

关 键 词：肠肿瘤/外科学 胃肠道间质瘤/诊断 胃肠道间质瘤/治疗 预后 

分 类 号：R735.3[医药卫生—肿瘤]