胃间质瘤致上消化道出血临床诊治探讨  

Discussion on Clinical Diagnosis and Treatment of Upper Gastrointestinal Bleeding Caused by Gastric Stromal Tumors

作　　者：胡陈睿 孙明兵 赵鑫[1] 虞竹雯 肖坤庭 HU Chen-rui;SUN Ming-bing;ZHAO Xin;YU Zhu-wen;XIAO Kun-ting(Department of General Surgery,the First Affiliated Hospital of Soochow University,Suzhou,Jiangsu,215006,China;Department of Gastroenterology,the First Affiliated Hospital of Soochow University,Suzhou,Jiangsu,215006,China;Department of Geriatric Medicine,the First Affiliated Hospital of Soochow University,Suzhou,Jiangsu,215006,China)

机构地区：[1]苏州大学附属第一医院普外科,江苏苏州215006 [2]苏州大学附属第一医院消化内科,江苏苏州215006 [3]苏州大学附属第一医院老年医学科,江苏苏州215006

出　　处：《中国血液流变学杂志》2022年第1期27-31,43,共6页Chinese Journal of Hemorheology

基　　金：国家自然科学基金资助项目(31770985,82073180);江苏省社会发展项目(BE2019665);苏州市“姑苏卫生人才”计划青年拔尖人才(2018-057);江苏省青年医学人才(QNRC2016732);江苏省“333工程”科研项目(BRA2019327);姑苏卫生人才培养项目(GSWS2019028);苏州市科技计划(SYS2019053,SLC201906)。

摘　　要：目的探讨胃间质瘤致上消化道出血的诊治。方法回顾性分析2016年6月—2019年6月收住入院的胃间质瘤致上消化道出血病例36例。对该组病例术前检查(包括胃镜和CT检查)和肿瘤相关指标(包括CA125、CA199、CYFRA211、CA72-4、CA153、SCCA、AFP、CEA)以及术后病理和免疫组化(包括CD117、CD34、vimentin、SMA)进行统计分析。术后随访时间为术后3、6、12、24、36个月,主要通过电话进行随访。结果患者行CT检查和(或)胃镜以初步诊断,所有患者经手术治疗,手术方式包括胃肿瘤剜除术,全胃切除术,胃部分切除术等。该组中,1例(2.8%,1/36)CA125>35 U/mL,该例确诊为胃间质瘤腹腔转移。CT检查主要表现为团块状软密度影,增强不均匀。术后免疫组化显示CD117、CD34、vimentin阳性率均在90%以上,SMA均为阴性。随访三年生存率为90.0%(27/30)。结论该病初步诊断通过CT检查,尽可能完善胃镜检查,既可以明确诊断,又可以胃镜下止血;病灶完整切除是治疗该病的首选;CA125的检测有可能对肿瘤的良恶性行为做出初步指导;术后病理和免疫组化是确诊该病的金标准;该病预后较好,早期切除病灶可以获得良好收益。Objective To discuss the diagnosis and treatment of upper gastrointestinal bleeding caused by gastric stromal tumor.Methods This study retrospectively analyzed 36 cases of upper gastrointestinal bleeding caused by gastric stromal tumor admitted in the First Affiliated Hospital of Soochow University from June 2016 to June 2019.Preoperative examination(including gastroscopy and CT examination),tumor-related indicators(including CA125,CA199,CYFRA211,CA72-4,CA153,SCCA,AFP,CEA),postoperative pathology and immunohistochemistry(including CD117,CD34,vimentin,SMA)of this groups of cases were statistically analyzed.The postoperative follow-up was 3 months,6 months,12 months,24 months,and 36 months.The follow-up was mainly conducted by telephone.Results The patients underwent CT examination and/or gastroscopy for preliminary diagnosis.All patients were treated with surgery,including gastric tumor enucleation,total gastrectomy,and partial gastrectomy.In this study group,1 case(2.8%,1/36)CA125>35 U/mL,was diagnosed as gastric stromal tumor with abdominal cavity metastasis.CT examination mainly showed mass-like soft density shadows with uneven enhancement.Postoperative immunohistochemistry showed that the positive rates of CD117,CD34,and vimentin were all over 90%,and SMA were all negative.The three-year follow-up survival rate was 90.0%(27/30).Conclusion The initial diagnosis of the disease is through CT examination,and the gastroscopy is as perfect as possible,which can not only confirm the diagnosis,but also stop bleeding under gastroscop.Complete resection of the lesion is the first choice for the treatment of the disease.CA125 detection may provide preliminary guidance for the benign and malignant behavior of the tumor.Postoperative pathology and immunohistochemistry are the gold standards for diagnosing the disease.The prognosis of the disease is good,and early resection of the lesion can obtain good result.

关 键 词：胃间质瘤 出血 胃镜检查 免疫组化 病理 

分 类 号：R735.2[医药卫生—肿瘤]