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目的探讨胃肠间质瘤(GIST)的临床特征、诊断、治疗方法、病理学特征、免疫组织化学分析及相关预后因素。方法回顾性分析我院42例GIST的临床资料。结果GIST的主要临床表现为腹胀、腹痛15例,消化道岀血9例。腹部肿块7例。肿瘤位于胃者22例,小肠12例。其他分布在结肠、肠系膜、网膜及腹膜后。肿瘤长径0.8～25.0cm,平均7.5cm。42例标本CD117阳性,40例标本Vimentin阳性,36例标本CD34阳性。全组均手术治疗,切除率100%。18例恶性GIST及4例潜在恶性GIST患者术后进行了传统的静脉化疗。其中3例有术后复发或转移的患者接受了格列卫(络氨酸激酶受体抑制剂)治疗。经随访42例患者1、3、5年生存率分别为93.5%、62.1%和33.2%。结论GIST临床症状无特异性,术前确诊率低,确诊主要依靠手术后病理学观察及免疫组化检测。肿瘤的大小是判断良恶性GIST的重要指标。目前GIST的治疗仍以手术切除为主,复发的病例亦可反复手术取得较为满意的效果。
Objective To investigate the clinical features, diagnosis, treatment, histopathological features, immunohistochemical analysis and related prognostic factors of gastrointestinal stromal tumors (GIST). Methods The clinical data of 42 cases of GIST in our hospital were retrospectively analyzed. Results The main clinical manifestations of GIST were abdominal distension, abdominal pain in 15 cases and gastrointestinal bleeding in 9 cases. Abdominal mass in 7 cases. Tumors in the stomach in 22 cases, 12 cases of small intestine. Other distribution in the colon, mesentery, omentum and retroperitoneal. Tumor diameter 0.8 ~ 25.0cm, an average of 7.5cm. 42 specimens were positive for CD117, 40 specimens were positive for Vimentin and 36 specimens were positive for CD34. All patients were surgical treatment, resection rate of 100%. Eighteen patients with malignant GIST and four patients with potentially malignant GIST underwent conventional intravenous chemotherapy. Three of the patients who had postoperative recurrence or metastasis received treatment with Gleevec (tyrosine kinase receptor inhibitor). The 1, 3, 5-year survival rates of 42 patients were 93.5%, 62.1% and 33.2% respectively. Conclusion The clinical manifestations of GIST are nonspecific, and the preoperative diagnosis rate is low. The diagnosis mainly depends on the postoperative pathological observation and immunohistochemistry. The size of the tumor is an important indicator of benign and malignant GIST. The current treatment of GIST is still the main surgical resection, recurrent cases can be repeated surgery to obtain more satisfactory results.