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目的探讨胃肠道间质瘤(GISTs)的临床及病理学表现、诊断及治疗。方法回顾性分析首都医科大学附属北京友谊医院普外科1999年12月至2006年5月间收治44例胃肠道间质瘤病人的临床及病理资料。结果其中50岁以上32例。首发症状:消化道出血17例,腹痛和腹部不适13例,腹部肿块8例,体检发现6例。完全切除38例;肿瘤无法完整切除6例。肿瘤部位:胃21例,小肠11例,直肠6例,十二指肠3例,肠系膜3例。肿瘤直径:>10cm7例,5～10cm9例,<5cm28例。核分裂≤5/5OHPF16例,>5/5OHPF28例。肿瘤性质恶性14例,潜在恶性13例,良性17例。免疫组化结果:CD117阳性44例(100%),CD34阳性31例(70.5%),vi-mentin阳性40例(90.9%),Desmin无阳性。结论胃肠道间质瘤在50岁以上人群好发,以消化道出血、腹痛和腹部不适、腹部肿块表现为主。好发于胃和小肠。肿瘤的大小和核分裂数是胃肠道间质瘤良、恶性的重要临床指标。GISTsCD34、CD117及vimentin的阳性率较高,而Desmin多无表达。完整的局部手术切除是最有效的首选治疗手段。对无法切除或有肿瘤残余及术后复发的病人可应用甲磺酸伊马替尼进行治疗。
Objective To investigate the clinical and pathological features, diagnosis and treatment of gastrointestinal stromal tumors (GISTs). Methods Retrospective analysis of clinical and pathological data of 44 patients with gastrointestinal stromal tumors admitted to Department of General Surgery, Beijing Friendship Hospital, Capital Medical University from December 1999 to May 2006. Results of which more than 50 years old in 32 cases. The first symptom: gastrointestinal bleeding in 17 cases, 13 cases of abdominal pain and abdominal discomfort, abdominal mass in 8 cases, physical examination found in 6 cases. Complete excision of 38 cases; tumor can not be completely removed in 6 cases. Tumor site: stomach 21 cases, 11 cases of small intestine, 6 cases of rectum, 3 cases of duodenum, 3 cases of mesentery. Tumor diameter:> 10cm7 cases, 5 ~ 10cm9 cases, <5cm28 cases. Nuclear fission ≤ 5 / 5OHPF16 cases,> 5 / 5OHPF28 cases. Malignant tumor in 14 cases, potentially malignant in 13 cases, benign in 17 cases. Results of immunohistochemistry showed that there were 44 positive cases (100%) of CD117, 31 positive cases of CD34 (70.5%) and 40 cases (90.9%) positive of vi-mentin. Desmin was not positive. Conclusions Gastrointestinal stromal tumors are predominant in people over 50 years of age with gastrointestinal bleeding, abdominal pain and abdominal discomfort. Occur in the stomach and small intestine. Tumor size and mitotic number of gastrointestinal stromal tumors of benign and malignant important clinical indicators. The positive rates of GISTs CD34, CD117 and vimentin were high, but there was no expression of Desmin. Complete local surgical resection is the most effective treatment of choice. For patients who can not be removed or have residual tumor and postoperative recurrence, imatinib mesylate can be treated.