胃肠道间质瘤90例的临床诊治及病理分析

摘要

Objective To investigate the age of onset,location,clinical feature,diagnosis,immunohistochemical characteristic and treatment status of gastrointestinal stromal tumor.Methods Retrospectively analyzed the position,clinical feature,methods of diagnosis and treatment,pathological and immunohistochemical characteristics of 90 cases of gastrointestinal stromal tumor who were confirmed by pathological and immunohistochemical examination in our hospital nearly 9 years.Results Gastrointestinal stromal tumor incidence ratio was 1.5:1 for men and women.The range of age was 21-86 years old,most of patients over 60 years old.Gastrointestinal stromal tumor mainly originated in stomach (55.6％) or small intestine (27.8％).Clinical manifestations lacked specificity,and initial symptoms mainly were haematemesis,melena or hematochezia,abdominal pain and abdominal distension.Clinical diagnosis of stromal tumor was difficult,correct diagnosis depended on histopathological and immunohistochemical examination of surgery or biopsy specimens.The positive rate of immunohistochemistry detecting CD117 was 94.05％ (79/84),that of CD34 was 92.86％ (78/84),and that of CD117 combined with CD34 was 92.86％ (78/84).Complete resection of lesion with operation is the only effective treatment method of gastrointestinal stromal tumor.Gleevec had a certain role for inoperable patients or in preventing recurrence.Conclusions Gastrointestinal stromal tumor is an undecided pluripotent mesenchymal tumor lacking of specific clinical manifestations.The diagnosis must depend on gross specimens or immunohistochemical pathology results.CD117 and CD34 have an important value in the diagnosis.Surgery resection is the only effective treatment method.%目的 探讨胃肠道间质瘤的发病年龄及部位、临床表现、诊断、免疫组化特点及治疗现状.方法 回顾性分析本院近9年来住院病人资料,分析经过病理和免疫组化检查确诊的90例胃肠道间质瘤病人的发病部位、临床表现、诊治方法、病理及免疫组化特点.结果 胃肠道间质瘤男女发病比例为1.5∶1.发病年龄范围为21 ～ 86岁,60岁以上患者比例最高.所有患者的胃肠道间质瘤主要起源于胃(55.6％)和小肠(27.8％).临床表现缺乏特异性,首发症状主要为呕血、黑便或便血,腹痛、腹胀等.间质瘤的临床诊断是困难的,其正确诊断依赖于手术或活检标本的病理组织学和免疫组化检查确定,免疫组化检测CD117阳性率94.05％(79/84),CD34阳性率92.86％(78/84),两者同时为阳性者78例(92.86％).本病的治疗以手术彻底切除病变为唯一有效的方法,格列卫对不能手术者或对预防术后复发有一定的作用.结论 胃肠道间质瘤是一种未定的多潜能的间叶源性肿瘤,其临床表现缺乏特异性,确诊须依赖大体标本或免疫组化病理结果,CD117和CD34对诊断有重要价值,手术切除是唯一有效的治疗方法.