十二指肠间质瘤的诊断与治疗  

Diagnosis and treatment of duodenal gastrointestinal stromal tumors

作　　者：李永盛[1] 陈丹磊[1] 江翰[1] 边睿[1] 贺思佳 张文杰[1] 刘颖斌[1] 施伟斌[1] 

机构地区：[1]上海交通大学医学院附属新华医院普通外科胆道研究所,200092 [2]上海交通大学医学院附属新华医院消化内科内镜诊治部小儿营养重点实验室,200092

出　　处：《中华消化外科杂志》2014年第10期793-796,共4页Chinese Journal of Digestive Surgery

摘　　要：目的 探讨十二指肠间质瘤的诊断与治疗.方法 回顾性分析2009年1月至2013年12月上海交通大学医学院附属新华医院收治的14例十二指肠间质瘤患者的临床资料,分析患者的临床表现、影像学检查结果.依据肿瘤的部位、大小及周边浸润情况选择手术方式,术后根据患者肿瘤危险程度分级标准分为高、中、低危险期,针对性进行化疗.通过电话及门诊随访,每3个月随访1次,随访期间询问患者症状,行体格检查和血生化、胸部X线片、腹部CT等检查了解患者预后.随访时间截至2014年8月.计数资料采用x2检验,Kaplan-Meier法计算生存率,生存分析采用Log-rank检验.结果 临床表现首发症状为反复黑便7例、右季肋区胀痛不适3例、无痛性右季肋区包块2例、急性大出血1例、黄疸1例.术前9例患者行腹部B超检查,其中4例腹腔占位性病变考虑来源于十二指肠区;14例患者行CT检查,其中9例提示十二指肠占位性病变;12例患者行内镜及EUS检查,其中11例提示十二指肠壁呈外压性改变或黏膜下隆起;11例患者行活组织病理检查,其中8例确诊为间质瘤.14例患者均达到根治性切除,其中行胰十二指肠切除术7例,行局部手术7例（肿瘤局部切除＋修补术2例、十二指肠肠段切除术4例、远端胃大部切除术1例）.术后发生胰瘘1例、胃瘫2例、吻合口瘘3例,均经非手术治疗后痊愈.行胰十二指肠切除术患者并发症发生率为5/7,高于行局部切除术患者的1/7（x2=4.667,P＜0.05）.术后肿瘤标本直径为2.5～ 10.0 cm,平均肿瘤直径为4.5 cm;其中＜5.0 cm者10例,≥5.0 cm者4例,术中未发现肿大可疑的转移淋巴结,术中及术后病理检查淋巴结转移均为阴性.病理诊断均为十二指肠间质瘤.核分裂象数：＜5个/50个高倍视野者9例,≥5个/50个高倍视野且＜10个/50个高倍视野者3例,≥10个/50个高倍视野者2例,免疫组织化学染色检测：CD34阳性12例,CD117Objective To investigate the diagnosis and treatment of the duodenal gastrointestinal stromal tumors （GISTs）.Methods The clinical data of 14 patients with duodenal GISTs who were admitted to the Xinhua Hospital of the Shanghai Jiaotong University from January 2009 to December 2013 were retrospectively analyzed.The clinical presentation and results of imaging examination were analyzed.The surgical procedures were selected according to the location and size of the tumor and tumor infiltration.Chemotherapy was applied according to the risks of the tumor after the operation.Patients were followed up via phone call or out-patient examination every 3 months to learn the symptoms,and the prognosis of the patients was evaluated by body examination,blood biochemistry test,chest X-ray examination.Patients were followed up till August 2014.The count data were analyzed using the chi-square test,the survival rate was analyzed by Kaplan-Meier method,and the survival was analyzed by Log-rank test.Results The initial symptoms included melaena in 7 cases,discomfort in the right hypochondriac region of the abdomen in 3 cases,painless mass in the right hypochondriac region of the abdomen in 2 cases,acute upper gastrointestinal hemorrhage in 1 case and jaundice in 1 case.All the 9 patients received B-sonography,and the space-occupying lesions were originated from the duodenum in 4 patients; 14 patients received computed tomography,and 9 patients had duodenal space-occupying lesions; 12 received endoscopy and endoscopic ultrasonography,compressed changes or submucosal apophysis were detected in 11 cases; 11 patients received histopatholgical examination and 8 patients were confirmed as with stromal tumors by biopsy.Fourteen patients received radical resection,including pancreaticoduodenectomy in 7 cases and local resection in 7 cases （local resection ＋ repair in 2 cases,duodenectomy in 4 cases and distal subtotal gastrectomy in 1 case）.One patient was complicated with pancreatic fistula,2 with gastroplegia and 3 with anasto

关 键 词：十二指肠肿瘤 胃肠道间质瘤 诊断 治疗 

分 类 号：R735.31[医药卫生—肿瘤]