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目的:探讨胃肠道间质瘤的临床病理诊断与治疗方法。方法:回顾性分析100例胃肠道间质瘤的临床病理资料。结果:CT平扫探查发现所有患者肿块均为单发,79例良性肿块可见软组织密度肿块,密度均匀;21例恶性肿块内可见大小不等的低密度坏死区,呈分叶状。双期增强扫描见肿块腔内侧大小不一的溃疡,其中7例恶性间质瘤的溃疡程度大而深;增强扫描肿块呈不均匀明显强化,囊变坏死区无强化。病变发生在胃部56例,十二指肠26例,小肠10例,结肠及直肠6例,肠系膜2例。术中标本的病理学检测发现由梭形瘤细胞形成的细胞团巢是胃肠道间质瘤的特征排列。所有病例均完整切除,均未发现淋巴结转移,术中及术后均无死亡,平均住院时间15.2 d。随访期6~24个月,其中5例恶性肿瘤患者死亡,均死于肝转移;28例复发(28.0%),其中肿瘤类型:交界性肿瘤12例,恶性肿瘤16例;复发部位:局部复发16例,腹膜复发12例;再次进行切除手术后随访3个月,均存活。结论:胃肠道间质瘤可根据其临床表现、CT等影像学检查以及病理学检测等明确诊断,早行手术切除效果良好。
Objective: To investigate the clinicopathological diagnosis and treatment of gastrointestinal stromal tumors. Methods: A retrospective analysis of 100 cases of gastrointestinal stromal tumors of the clinicopathological data. Results: CT scan found that all patients were single mass tumor, 79 cases of benign mass visible soft tissue mass density, uniform density; 21 cases of malignant mass visible in the low-density necrosis of varying sizes, lobulated. Two-phase enhanced scan to see the different sizes of ulceration within the tumor cavity, of which 7 cases of malignant stromal tumor of large and deep ulcer; enhanced scan showed uneven heterogeneity, cystic necrosis no enhancement. Lesions occurred in 56 cases of the stomach, duodenum in 26 cases, 10 cases of small intestine, colon and rectum in 6 cases, 2 cases of mesentery. Pathological examination of intraoperative specimens found that cell clusters formed by spindle cells are characteristic of gastrointestinal stromal tumors. All cases were completely resected, no lymph node metastasis, no death during and after surgery, the average length of stay 15.2 d. The follow-up period ranged from 6 months to 24 months. Five of the 5 patients died of malignant tumor and all died of hepatic metastasis. 28 patients relapsed (28.0%), of which 12 were borderline tumors and 16 malignant tumors. The recurrent sites were local recurrences 16 cases of peritoneal recurrence in 12 cases; again after resection surgery for 3 months, all survived. Conclusion: Gastrointestinal stromal tumor can be diagnosed according to its clinical manifestations, CT and other imaging tests as well as pathological examination. The results of early surgical resection are good.