以胃肠道出血首发的小肠间质瘤17例  

Diagnosis and treatment of intestinal stromal tumors initially manifesting as gastrointestinal hemorrhage:an analysis of 17 cases

作　　者：唐彤丹[1] 朱磊[2] 

机构地区：[1]大连市中心医院急诊科,辽宁省大连市116033 [2]大连医科大学附属第一医院消化科,辽宁省大连市116011

出　　处：《世界华人消化杂志》2011年第4期425-428,共4页World Chinese Journal of Digestology

摘　　要：目的:提高对以胃肠道出血首发的小肠间质瘤的了解和早期诊治.方法:回顾性分析17例以胃肠道出血首发的小肠间质瘤患者的临床表现、血红蛋白水平、小肠CT表现、手术病理、免疫组织化学以及随访结果等临床资料.结果:以胃肠道出血首发的小肠间质瘤多好发于中老年人,平均年龄58岁,男性略多于女性,临床表现为便血和不同程度的贫血.小肠CT检查有助于发现病灶,16例患者小肠CT发现小肠占位病变,表现为无分叶或有分叶的低密度、边界清晰软组织肿块,平均CT值32HU,强化大多不均匀,多数无淋巴结转移.肿瘤多为外生性生长,17例患者CD117免疫组织化学检测均阳性.组织病理学以及CD117、CD34免疫组织化学有助于肿瘤的确诊和危险分类,治疗方法主要为手术切除.结论:重视急诊胃镜、肠镜检查阴性的以胃肠道出血的小肠间质瘤患者,小肠CT检查有助于发现病变,并经手术切除病灶、生物靶向治疗、加强随访以改善患者预后.AIM：To improve the understanding,early diagnosis and treatment of intestinal stromal tumors initially manifesting as gastrointestinal bleeding.METHODS：The clinical data for 17 patients with intestinal stromal tumors initially manifesting as gastrointestinal hemorrhage were analyzed retrospectively,including clinical manifestations,hemoglobin concentration,intestinal computed tomography（CT） imaging data,pathological data,immunohistochemistry data,and followup data.RESULTS：Intestinal stromal tumors initially manifesting as gastrointestinal bleeding occurred more frequently in elderly patients whose average age was 58 years.Males were slightly more likely to suffer from the disease than females.Hematochezia and varying degrees of anemia were the major clinical manifestations.CT scan of the intestine was helpful for finding the tumors showing exophytic growth without lymphatic metastasis.Intestinal tumors,which presented as low-density,sharply marginated,lobulated or unlobulated soft masses,were found in 16 patients on CT scan.These tumors had an average computed tomographic value of 32 Hounsfield units.Enhanced CT scan showed that the majority of tumors exhibited inhomogeneous enhancement.All patients were positive for CD117.Histopathology and immunohistochemistry can help establish a confirmative diagnosis and conduct risk classification.Surgery was the first choice of treatment for the disease.CONCLUSION：CT scan is helpful in finding intestinal stromal tumors initially manifesting as gastrointestinal bleeding.The prognosis of intestinal stromal tumors could be improved by surgery and biological targeted therapy.

关 键 词：胃肠道出血 小肠间质瘤 计算机断层扫描 

分 类 号：R735.3[医药卫生—肿瘤]