上消化道胃肠道间质瘤的内镜及临床分析  

Endoscopic and clinical character analysis of upper gastrointestinal tract gastrointestinal stromal tumor

作　　者：王雪梅[1] 刘玉兰[1] 

机构地区：[1]北京大学人民医院消化内科,100044

出　　处：《中华临床医师杂志（电子版）》2015年第16期46-49,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的探讨上消化道胃肠道间质瘤(GIST)的内镜、病理及免疫组化特征,以提高内镜医生对该疾病的认识和诊断,减少误诊和漏诊。方法检索我院2007年1月至2010年4月所有经手术治疗的GIST,选择病变部位在食管、胃、十二指肠的病例,分析其临床表现、胃镜表现,辅助检查、手术病理及免疫组化结果。结果 30例患者中,以消化道出血为主要症状的患者11例(36.7%),腹痛的患者6例(20%),腹部不适的4例(13.3%),查体发现的3例(10%)。GIST部位:胃底12例(40%),胃体7例(23.3%)。胃镜下表现:(1)黏膜下隆起,表面光整,12例;(2)黏膜下隆起伴顶端溃疡7例;(3)溃疡型肿物4例;(4)黏膜下隆起顶端凹陷3例;(5)黏膜下隆起表面增殖糜烂1例;(6)黏膜下隆起伴糜烂2例;(7)胃镜阴性:1例。其中14例行超声内镜检查,多数病变来源于固有肌层。29例病理为梭形细胞肿瘤,免疫组化:CD117阳性29例(96.7%),CD34阳性27例(90%)。结论上消化道GIST临床表现多样,症状以消化道出血和腹痛、腹部不适为多。胃镜下表现不一,表现为黏膜隆起性病变,40%的病例黏膜表面光整,56.7%的病例呈溃疡表现或糜烂,少数病例肿物表面增殖,与胃癌不易鉴别。超声胃镜的诊断率高。Objective To investigate the gastroscopy, pathological and immunohistochemistry characteristics of upper gastrointestinal GIST, in order to improve the recognition and diagnosis of endoscopic doctor of the disease, reduce misdiagnosis and missed diagnosis. Methods Clinical manifestation, endoscopy, operation pathology and immunohistochemical data of 30 upper gastrointestinal GIST from January 2007 to April 2010 of Peking University People＇s hospital were analyzed retrospectively. Results The main clinical manifestations of GIST included gastrointestinal hemorrhage in 11 cases （36.7%）, abdominal pain in 6 cases （20%）, abdominal discomfort in 4 cases （13.3%）. Of the 30 eases of GIST, 12 （40%） were at the fimdus, 7 （23.3%） were at the body. Endoscopically, in 30 GIST patients, 12 cases showed submucosal protuberant global or half-global lesions; 7 cases were presented as submucosal protuberant with ulcer; 4 cases were ulcer-like tumors; 3 cases were submucosal protuberant with hollow on the top; 1 case was the submucosal surface erosion and proliferation; 2 cases were submucosal protuberant .with erosion; I case was negative. 14 cases underwent endoscopic ultrasonography, most eases of the stromal tumors were from muscularis. Pathology revealed the typical stromal tumor features with cell in spindle shape. Immunohistochemical examination demonstrated CDI 17 positive rate was 96.7% （29/30）, CD34 positive rate was 90% （29/30）. Conclusion Most clinical manifestation of upper gastrointestinal GIST were gastrointestinal bleeding and abdominal pain, abdominal discomfort. Gastroscopic features of GIST were varied. Most were submucosal protuberant, 40% cases of the surface were smooth, 56.7% cases of surface with erosion or ulcer. A few cases of tumor, the surface present proliferation, it＇s difficult to distinguish t^om cancer. The diagnosis rate of endoscopic ultrasound was satisfied.

关 键 词：胃肠道间质肿瘤 胃镜 免疫组织化学 诊断 

分 类 号：R735[医药卫生—肿瘤]