十二指肠间质瘤29例诊治分析  

Diagnosis and surgical treatment of duodenal gastrointestinal stromal tumor： a report of 29 patients

作　　者：杨峰[1] 金忱[1] 王强[1] 李骥[1] 蒋永剑[1] 狄扬[1] 姚冽[1] 郝思介[1] 王晓乙[1] 何航[1] 傅德良[1] 

机构地区：[1]复旦大学上海医学院附属华山医院胰腺外科胰腺病研究所,200040

出　　处：《中华肝胆外科杂志》2013年第8期572-575,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的总结十二指肠间质瘤的诊断和外科治疗经验。方法回顾性分析1999年5月至2013年3月我院诊治的29例十二指肠间质瘤病例资料。结果29例患者主要临床表现为黑便、中上腹不适或腹痛。术前诊断主要依据影像学和内镜检查，但活检准确率低。内镜超声引导下细针穿刺活检有助于明确诊断。29例患者均完整切除肿瘤。其中13例行胰十二指肠切除；11例行肿瘤局部切除；5例行十二指肠节段切除。术后7例服用伊马替尼。术后随访2～118个月，平均48．2个月。26例患者存活至今。其中23例无复发或转移征象；4例出现肝脏转移；2例肿瘤复发。核分裂相≥5／50高倍视野（HPF）为术后复发转移的高危因素。结论十二指肠间质瘤首选手术切除，根据肿瘤大小和位置选择合理的手术方式。早期诊断和完整切除肿瘤对改善预后至关重要。肿瘤破裂或高危患者术后应给予口服伊马替尼辅助治疗。Objective To review our experience in the diagnosis and surgical treatment of duodenal gastrointestinal stromal tumor （GIST）. Methods A retrospective study was conducted on 29 patients with duodenal GISTs diagnosed and treated in our hospital between May 1999 and March 2013. Results The clinical symptoms included melaena, and upper abdominal discomfort or pain. The preoperative diagnosis depended on imaging and endoscopy, but tumour biopsy had a low accuracy. Endoscopic ultrasound guided fine needle aspiration （EUS-FNA） helped to confirm the diagnosis in some patients. All these patients received curative surgical resection successfully. The operations included 13 pancreaticoduodenectomy, 11 local duodenal resections and 5 segmental duodenectomy. Imatinib was given to 7 patients postoperatively. At a mean follow-up of 48.2 months （range 2-118）, 23 patients were alive with no evidence of recurrence or metastasis. Four patients had developed liver metastasis, and two patients had developed tumor recurrence. A Mitotic count ≥5/50 high-power field （HPF） was a risk factor of post-operative recurrence and metastasis. Conclusions Surgical resection is the best treatment for duodenal GIST. The optimal surgery depends on the tumor size and location. Early diagnosis and complete tumor resection are important for a good prognosis. Patients with tumor rupture or high risk grading should be given imatinib therapy postoperatively.

关 键 词：十二指肠肿瘤 胃肠道间质瘤 诊断 外科治疗 

分 类 号：R735.31[医药卫生—肿瘤]