72例胃肠道间质瘤治疗的回顾性研究

摘要

背景与目的:胃肠道间质瘤(gastrointestinal stromal tumor,GIST)是一组起源于胃肠道肌层的间叶性肿瘤,以往外科手术是唯一治疗手段,随着CD117和CD34在肿瘤中表达的发现及分子靶向药物的出现,GIST的诊治有了重大进展.本研究回顾性分析72例手术治疗的GIST患者的临床资料,探讨GIST的诊断和治疗方法.方法:回顾性分析72例手术治疗的GIST患者的临床资料.术前采用消化内镜、B超及CT等影像学方法,所有患者予手术治疗,对其术后病理、临床诊断和治疗方法进行分析.结果:本组患者平均发病年龄为54.3岁.本病临床表现无特异性,常以腹部肿物和消化道出血为首发症状.消化内镜、B超及CT等检查可发现肿瘤,免疫标记物CD117、CD34在GIST中有较高表达,通过病理组织学及免疫组化检查可明确诊断.术后发生胃瘫5例,吻合口瘘2例,胰瘘1例,均经保守治疗后治愈或好转,平均随访时间为36个月.31例恶性间质瘤患者中有16例术后采用甲磺酸伊马替尼治疗(400 mg/d),其中4例复发,15例未作治疗的患者中有8例复发,差异有统计学意义(P<0.01).结论:CD117和CD34联合使用可协助鉴别诊断GIST.手术完整切除肿瘤仍然是首选治疗方法,分子靶向药物在新辅助治疗和术后辅助治疗中前景乐观.%Background and purpose: Gastrointestinal stromal tumor (GIST) originates from gastrointestinal muscular mesenchymal tissue.In the past, surgery was the only effective treatment method.However, diagnosis and treatment of GIST have made great progress since CD 117 and CD34 were discovered in these tumors and molecular targeted drugs were found.This study retrospectively investigated the clinical diagnosis and treatment of 72 cases of GIST have undergone surgical treatment.Methods: The clinical data of the 72 GIST patients were retrospectively analyzed.All the patients were diagnosed with digestive endoscopy, B ultrasonic imaging method, CT before operation.Pathological diagnosis was made after operation.Results: The average age of onset was 54,3.No specificity in manifestations were observed.Initially most of the GIST patients presented alimentary tract hemorrhage and abdominal mass.Tumors could be detected through digestive endoscopy, CT or ultrasonography.The immunological markers CD117 and CD34 were highly expressed in GIST.The diagnosis could be confirmed via histology and immunohistology.Postoperative stomach paralysis occurred in 5 cases, anastomosis fistula in 2 cases, pancreatic fistula in 1 case, all the complications were cured by conservative treatment.The average follow-up was 36 months.In 31 cases, 16 cases used imatinib (400 mg/d), in which 4 cases recurred; the other 15 cases without imatinib, 8 cases recurred (P＜0.01).Conclusion: CD117 and CD34 tumor markers is helpful in diagnosing GIST.Surgical resection of the tumors is still the most effective treatment for GIST.The outlook for targeted therapy in post-operative radiotherapy and chemotherapy seems optimistic.