胃肠外间质瘤31例临床分析

摘要

Objective To improve the diagnosis and treatment of extragastrointestinal stromal tumors (EGIST). Methods The clinical data of 31 cases of EGIST confirmed pathologically from Jan. 2004 to Sep. 2009 were retrospectively analyzed: 4 cases in our hospital, and 27 case in No. 161 Hospital of PLA. Results All the patients were treated surgically. Twenty-five cases were subjected to complete resection, 5 cases to palliative operation, one case to biopsy and 3 cases to combined organ resection. During a follow-up period of 2 to 6 years, one- and 2-year mortality due to recurrence or metastasis was 6. 4% and 19. 4% respectively. Seventeen cases survived up to date. Sixteen cases had no recurrence and metastasis. Conclusion EGIST has a low prevalence clinically, and no specific clinical presentations. Imaging detections are the main diagnostic methods preoperatively, but qualitation of tumors is difficult. The prognosis of EGIST is related to tumor location. The EGIST originated from greater omentum have better prognosis. Surgical operation remains the main treatment of EGIST. Complete resection is the principal treatment. Laparoscopic surgery is not suitable for EGIST which is more than 5 cm in diameter.%目的 提高胃肠外间质瘤(EGIST)诊断和治疗的认识.方法 回顾分析2004年1月至2009年9月洪湖市第二人民医院4例和解放军第一六一医院27例已确诊EGIST的临床资料.结果 本组均手术治疗,完整切除25例,行姑息手术5例,仅行活检术1例.其中联合脏器切除3例,行腹腔镜探查中转开腹2例.所有标本经过常规病理检查及免疫组织化学确诊.术后随访2～6年,因肿瘤复发或转移1年和2年病死率分别为6.4％和19.4％.至今仍存活17例,16例无复发及转移,其中发生部位位于大网膜者11例,肠系膜5例.结论 发生部位位于胃肠外,组织学符合胃肠道间质瘤,CD117(+)、CD34(+)者可做出EGIST诊断.良恶性的判断主要依据细胞的核分裂象数,有无转移和侵袭邻近器官.手术是唯一能治愈的方法.瘤体直径＞5 cm者不适合行腹腔镜手术.病人预后与发病部位有关.