胃肠道间质瘤32例临床诊治分析(1)
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【摘要】 目的 探讨胃肠道间质瘤的诊断和治疗。方法 回顾性分析2004年9月至2009年12月收治的32例胃肠道间质瘤患者的临床及病理资料。结果 32例胃肠道间质瘤病例中,22例(68.8%)为胃间质瘤,其他为小肠,结肠和直肠间质瘤。CD117阳性率96.9%,vimentin阳性率100%,CD34阳性率76.5%。32例均行手术治疗。肿瘤根治性切除25例,包括近端或远端胃大部切除,胃楔形切除,病变肠段切除,腹会阴联合切除及肿块切除或扩大切除,因肿瘤广泛粘连,无法完整切除7例。结论 胃肠道间质瘤的确诊主要依靠病理及免疫组化,CD117是诊断胃肠道间质瘤的重要标记物,完整的局部手术切除是最有效的治疗手段,对无法切除或有肿瘤残余及术后复发的患者可应用甲磺酸伊马替尼(格列卫)进行治疗。
【关键词】胃肠道间质瘤;诊断;手术治疗
Clinical analysis for diagnosis and treatment of 32 cases of gastrointestinal stromal tumors
LIU Ying-qiang,JI She-qing,ZHANG Bin.Department of Gastroenterological Surgery,the Tumor Hospital of Henan,Zhengzhou 450008,China
【Abstract】 Objective To investigate the diagnosis and treatment for gastrointestinal stromal tumors(GIST).Methods From Subtember 2004 to Desmber 2009,32 cases with gastrointestinal stromal tumors were analyzed retrospectively.Results Of the 32 cases ,31 case were positive for CD117(31/32,96.9%),32 case were positive for vimentin(32/32,100%)and 26 cases were positive for CD34(26/32,76.5%).Among all the GISTs,22 cases occurred in stomach(68.8%),6 in small intestine(18.8%),1 in colon(3.1%)and 3 occurred in rectum(9.4%).All patients underwent operation.25 cases were treated with radical surgery,consist of proximal or distal gastrectomy,stomach wedge shaped excision,partial intestine resection,mile’s operation and tumorectomy or wide local excision.Other seven cases received palliative resection because of locally invasive disease.Conclusion The diagnosis of GIST depends on pathological observation and immunohistochemical study.CD117 is a sensitive marker for the diagnosis of GIST.Total resection of the tumor is the most effective measure for the patients.Imatinibmesylate(glivec)is beneficial to the terminal stage patients with unresectable,residual or recurrent tumor.
【Key words】Gastrointestinal stromal tumors; Diagnosis; Surgical treatment
胃肠道间质瘤(Gastrointestinal stromal tumors,GIST)是起源于胃肠道间叶组织,以梭形细胞为主要成分的间叶肿瘤,过去多误诊为胃肠道平滑肌瘤和平滑肌肉瘤。自1983年Mazur和Clark首次提出胃肠道间质瘤的概念以来,对GIST的认识随着临床病理技术和分子生物技术的发展而逐渐成熟。大量研究表明,c-kit基因的突变和KIT蛋白产物(CD117)的异常活化是GIST最重要的特征[1]。随着诊断标准的明确,GIST病例数近年来不断增多 ......
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