胃肠道神经鞘瘤患者19例临床分析  

Clinical analysis of 19 patients with gastrointestinal schwannoma

作　　者：程奕尊 澹台新兴 史海涛[1] 伍洁[2] 秦斌[1] 程妍[1] Cheng Yizun;Tantai Xinxing;Shi Haitao;Wu Jie;Qin Bin;Cheng Yan(Department of Gastroenterology,The Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004,China;Department of Pathology,The Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004,China)

机构地区：[1]西安交通大学第二附属医院消化内科,西安710004 [2]西安交通大学第二附属医院病理科,西安710004

出　　处：《中国综合临床》2022年第3期217-221,共5页Clinical Medicine of China

摘　　要：目的探讨胃肠道神经鞘瘤临床特征、诊断、治疗方法及预后。方法采用描述性研究,对西安交通大学第二附属医院2017年5月至2020年11月确诊的胃肠道神经鞘瘤患者的临床表现、内镜表现、病理特征、治疗方法及预后等进行回顾性病例分析。结果共收集19例患者,年龄范围45.0~70.0岁,其中女性占68.4%(13/19)。临床症状无特异性,部分患者无症状[15.8%(3/19)],可表现为腹痛[57.9%(11/19)]、恶心[31.6%(6/19)]、腹胀[(21.1%(4/19)]和食纳减退[(21.1%(4/19)]等,少数为消化道出血[(5.3%(1/19)]。肿瘤最常见于胃体[(42.1%(8/19)],其次为十二指肠[(15.8%(3/19)]。内镜下呈黏膜下肿块,易误诊为间质瘤。病理类型呈梭形细胞肿瘤,免疫组化染色S100、Vim均为阳性。大多数Ki-67染色增值率<5%[(57.9%(11/19)],少部分≥10%[(10.5%(2/19)]。治疗均采用内镜或外科手术。所有神经鞘瘤未发现复发和转移倾向。结论胃肠道神经鞘瘤是一种非常少见的消化道黏膜下肿瘤,大多数为良性,恶性罕见,术后病理是其确诊金标准。常见于中年女性,临床症状多样且无特异性,镜下与间质瘤等黏膜下肿瘤鉴别困难,随瘤体增大其恶变倾向增大,对于瘤体直径<3 cm无浆膜侵犯的肿瘤推荐内镜下切除,创伤小且无复发。Objective To investigate the clinical features,diagnosis,treatment and prognosis of gastrointestinal neurilemmoma.Methods A descriptive study was conducted to retrospectively analyze the clinical manifestations,endoscopic findings,pathological features,treatment methods and prognosis of patients with gastrointestinal neurilemmima diagnosed from May 2017 to November 2020 in the Second Affiliated Hospital of Xi'an Jiaotong University Results A total of 19 patients were collected,ranging in age from 45.0 to 70.0 years old,of whom 68.4%(13/19)were female.The clinical symptoms are non-specific,and some patients are asymptomatic(15.8%(3/19))and may present with abdominal pain(57.9%(11/19)),nausea(31.6%(6/19)),abdominal distension(21.1%(4/19))and decreased appetite(21.1%(4/19)),and a few with gastrointestinal bleeding(5.3%(1/19)).Tumors were most frequently found in the gastric body(42.1%(8/19)),followed by the duodenum(15.8%(3/19)).Endoscopic submucosal mass is easy to be misdiagnosed as stromal tumor.The pathological type showed shuttle cell tumor,immunohistochemical staining showed positive S100 and Vim,most Ki-67 staining proliferation rate was<5%(57.9%(11/19)),and a small part was≥10%(10.5%(2/19)).Treatment was either endoscopic or surgical.No tendency to recur and metastasize was found in any of the neurilemmimas.Conclusion Gastrointestinal neurilemmoma is a very rare submucosal tumor of the digestive tract,most of which are benign and rare in malignancy,and postoperative pathology is the gold standard for its diagnosis.Gastrointestinal neurilemmoma is common in middle-aged female,with diverse and non-specific clinical symptoms,difficult to differentiate from submucosal tumors such as stromal tumors,and its tendency to malignant transformation increases with tumor enlargement.Endoscopic resection is recommended for tumors with tumor diameter<3 cm without serosal invasion,with little trauma and no recurrence.

关 键 词：胃肠道神经鞘瘤 预后 诊断 治疗 

分 类 号：R735[医药卫生—肿瘤]