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1、小腸間質(zhì)瘤46例臨床特點(diǎn)及治療論文林克榮，劉建強(qiáng)，張志堅(jiān)【Abstract】AIM:Toexploretheclinicalcharacteristicsanddiagnosisandtherapeuticmethodofgastrointestinalstromaltumorsofthesmallintestine.METHODS:Clinicaldataof46casesofgastrointestinalstromaltumorsofthesmallintestineadmitted199206/20060

2、6edpathologicallyforallcases.RESULTS:Gastrointestinalstromaltumorsofthesmallintestineattackedbothmaleandfemale,aletofemaleratioas1.21∶1.Theageofthepatientsrangedfrom19to80(average53)years.Theagestageajorclinicalsignsincluded:abdomenpain,abdomenmass,anaemiaandsm

3、allboaltumorsofthesmallintestinehadpredilectioninthejejunumandduodenum.ThedetectionratecouldbeenhancedbyPETCT.Themosteffectivetherapyovalofthetumors.Glivecmightbehelpfulforpatientsetastasis.CONCLUSION:Theclinicalmanifestationsofgastrointestinalstromaltumorsoft

4、hesmallintestinearenonspecific.Thedetectionratecanbeimprovedbyrationalauxiliaryexaminations.Themosteffectivetherapyisoperationremoval.【Keyesothelioma;intestinalneoplasms;intestine,small【摘要】目的：探討小腸間質(zhì)瘤的臨床表現(xiàn)、診斷及治療方法.方法：對(duì)199206/200606收治的46例小腸間質(zhì)瘤的臨床資料進(jìn)行回顧性分析，所有病例均

5、經(jīng)手術(shù)和病理證實(shí).結(jié)果：小腸間質(zhì)瘤男女均有發(fā)病，男女比為1.21∶1.本組發(fā)病年齡19～80(平均53)歲,45～60歲年齡段發(fā)病率最高.腹痛、腹部包塊、貧血、小腸梗阻是本組最常見(jiàn)的臨床表現(xiàn).小腸間質(zhì)瘤多好發(fā)于空腸和十二指腸，PETCT可提高小腸間質(zhì)瘤檢出率.手術(shù)徹底切除病變，格列衛(wèi)對(duì)于姑息手術(shù)者或?qū)︻A(yù)防術(shù)后復(fù)發(fā)有較好的療效.對(duì)復(fù)發(fā)或遠(yuǎn)處轉(zhuǎn)移者再次手術(shù)可延長(zhǎng)生存期.結(jié)論：小腸間質(zhì)瘤臨床表現(xiàn)缺乏特異性；合理應(yīng)用輔助檢查方法可提高小腸間質(zhì)瘤檢出率；手術(shù)為本病目前的最佳選擇.【關(guān)鍵詞】間皮瘤；腸腫瘤；小腸0引言胃腸道間質(zhì)

6、瘤(gastrointestinalstromaltumor,GIST)是一種發(fā)生于消化道，起源于胃腸道壁Cajal細(xì)胞（ICC）或與Cajal細(xì)胞同源的間葉干細(xì)胞的梭形細(xì)胞腫瘤.freelaltumorsofthesmallintestine）早期的臨床癥狀、體征缺乏特異性，容易延誤診治.我院199206/200606收治小腸間質(zhì)瘤患者46例，現(xiàn)將臨床診治情況報(bào)告如下.1對(duì)象和方法1.1對(duì)象199206/200606收治小腸間質(zhì)瘤46例，男25例，女21例；年齡19～80（平均53）歲.首診以腹痛為主18例

7、；腹部包塊12例；貧血8例；腸梗阻6例.所有患者中有腹痛癥狀的29例.查體發(fā)現(xiàn)有腹部包塊22例；伴有不同程度貧血34例；發(fā)生腸梗阻13例；無(wú)陽(yáng)性癥狀及體征，體檢發(fā)現(xiàn)糞便潛血陽(yáng)性，后行膠囊內(nèi)鏡發(fā)現(xiàn)小腸間質(zhì)瘤的有2例.本組病例術(shù)前均行胃鏡及腹部B超檢查，行結(jié)腸鏡檢查33例，10例行全消化道鋇餐或碘油造影，行腹部CT檢查40例，其中行PETCT檢查18例，數(shù)字減影血管造影(DSA)檢查6例.1.2方法本組患者均予以手術(shù)治療，根據(jù)患者病情及術(shù)中情況決定手術(shù)方法，采用經(jīng)腹行小腸、腹腔腫塊摘除術(shù)或腹腔鏡下小腸腸段切除術(shù)，所有病

8、例手術(shù)標(biāo)本均行病理及免疫組化檢查.1.2.2診斷標(biāo)準(zhǔn)參照Franquemont和Appelman的診斷標(biāo)準(zhǔn),根據(jù)術(shù)后病理及免疫組化將46例患者分為良性、惡性間質(zhì)瘤.2結(jié)果2.1臨床表現(xiàn)及發(fā)病部位腹痛、腹部包塊、貧血、小腸梗阻是本組最常見(jiàn)的臨床表現(xiàn).小腸間質(zhì)瘤多好發(fā)于空腸和十二指腸（表1）.表1小腸間質(zhì)瘤46例的發(fā)病部位及主要癥狀或（和）體征（略