124例胃肠道间质瘤临床诊治分析

发布时间：2018-01-08 14:19

  本文关键词：124例胃肠道间质瘤临床诊治分析　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

  更多相关文章： 胃肠道间质瘤 临床特点 辅助检查 诊断治疗 预后分析

【摘要】：目的:通过对胃肠道间质瘤患者发病的一般情况、临床表现、各种辅助检查的优缺点、病理特征、诊断和治疗方法、预后情况及预后影响因素的分析。给临床诊治及预后预测提供理论依据,并促进临床医生对该疾病早期诊断和治疗水平的进步,减少误诊和漏诊。资料及方法:收集大连医科大学附属第一医院2007年01月-2016年08月期间经术后病理检查确诊的124例胃肠道间质瘤患者的临床病例资料;回顾性分析胃肠道间质瘤患者的临床资料,影像学检查方式即X线钡餐造影、内镜、EUS、MRI、MSCT、腹部B超等检查结果。根据对患者的跟踪随访,用单因素分析性别、年龄、肿瘤大小、部位、肿瘤有无转移、肿瘤是否完整切除、核分裂象及术后是否行靶向治疗与预后的关系。结果:(1)一般资料:统计了2007年01月至2016年8月期间大连医科大学附属第一医院收治的均经术后病理检查确定为胃肠道间质瘤患者124例,其中0-40岁患者占6例,41-60岁患者占52例,61-84岁患者占66岁,年龄最小患者为20岁,年龄最大患者为84岁,发病中位年龄为63岁。男性58例,女性66例,男女比例0.88:1。(2)临床表现:本组124例胃肠道间质瘤患者中,临床表现差异较大。其中最常见表现为体检时无意中发现为38例,占30.65%;其次为腹部不适(如腹痛、腹胀)为36例,占29.03%;再次为消化道出血(如呕血、黑便、便血)为17例,占13.71%;多种临床表现(如腹痛伴便血)为12例,占9.68%;恶心、呕吐、腹泻为8例,占6.45%;腹部肿物5例,占4.03%;排便习惯改变、消瘦4例,占3.23%,其他临床表现如吞咽困难、肠梗阻、肠穿孔等少见,总共4例,占3.23%。本组124例患者中,最常见发病部位为胃91例(73.39%)、其次为小肠17例(13.71%),十二指肠12例(9.68%),余食管、结肠、直肠、阑尾各一例。(3)辅助检查:124例患者中,85例行CT检查(平扫和或增强),检出腹部肿物者共78例,检出率91.76%,58例行内镜检查(胃镜或肠镜),内镜直视下见到肿物者42例,检出率为72.41%,12例患者行超声检查,发现肿物者8例,检出率为66.67%,行EUS及MRI检查者分别为12例及4例,检出率均为100%。(4)治疗方式:本文所研究的所有124例患者都经过手术治疗,其中经外科手术治疗的患者为121例,行根治性手术患者数119例,行姑息性手术患者数2例;内镜下切除治疗的患者为3例。术后使用伊马替尼分子靶向治疗的患者7例。(5)病理及免疫组化:描述生物学行为的124例患者中,极低风险、低风险、中度风险、高风险所占例数分别为14例、60例、24例、26例。按肿瘤直径2cm、2-5cm、5-10cm、10cm分组,所占例数及比例分别为25例(20.16%)、63例(50.81%)、25例(20.16%)、11例(8.87%)。全部124例病例术后病理及免疫组化均证实为GIST,其中CDll7(+)为119(95.97%),CD34(+)为106例(85.80%),S-100(+)为11例(8.87%),SMA(+)为19例(15.32%),Desmin(+)为9例(7.26%)。(6)随访:本研究124例患者中,共随访到89例,失访35例,随访率为71.11%。随访时间最短为2个月,最长为108个月,中位随访时间45个月。在89例随访病例中,术后死亡病例为10例,其中男性4例,女性6例。术后生存时间5到95个月不等。对患者进行生存结果分析显示,GIST预后与手术方式的选择(P=0.001)、肿瘤大小的差别(P=0.026)、术前肿瘤是否转移(P0.001)有关系,差异具有统计学意义。结论:(1)GIST可发生于任何年龄,发病的中位年龄为63岁,40岁以前很少发病,男女发病率差异不明显。(2)GIST的临床表现纷繁多样,辅助检查缺乏特异性,术前诊断较为困难。确诊主要依靠病理学及免疫组化检查。(3)原发无转移GIST患者的首选治疗方式为手术治疗,手术原则是是彻底切除病灶,保证切缘阴性,并且避免肿瘤破裂。(4)GIST预后与手术方式、肿瘤大小及术前肿瘤是否转移有关,差异具有统计学意义。
[Abstract]:Objective: through the general situation of gastrointestinal stromal tumor in the patients with clinical manifestations, advantages and disadvantages of various auxiliary examination, pathological features, diagnosis and treatment, analysis of prognostic factors and prognosis. To provide theoretical basis for clinical diagnosis and prognosis, and to promote the clinician to early diagnosis and treatment of the disease progress, reduce misdiagnosis and missed diagnosis. Materials and methods: -2016 during the 08 months of 2007 from the First Affiliated Hospital of Dalian Medical University after 01 months postoperative pathological examination diagnosed 124 cases of gastrointestinal stromal tumors in patients with clinical data; retrospective analysis of clinical data of patients with gastrointestinal stromal tumor, imaging methods X-ray radiography, endoscopy, EUS, MRI, MSCT, abdominal ultrasound examination results. According to the follow-up of the patients, with the single factor analysis of gender, age, tumor size, location, tumor metastasis, tumor Whether the relationship between complete resection, mitotic and postoperative targeted therapy and prognosis. Results: (1) general data: 2007 01 to August 2016 during the First Affiliated Hospital of Dalian Medical University were confirmed by postoperative pathological examination confirmed 124 cases of patients with gastrointestinal stromal tumor between statistics, which accounted for 0-40 years old patients in 6 cases, 41-60 years old accounted for 52 cases of patients, aged 61-84 patients accounted for 66 years old, the youngest patient was 20 years old, the maximum age of the patients was 84 years. The median age was 63 years old. 58 cases were male, 66 were female, male to female ratio of 0.88:1. (2) clinical manifestations: 124 cases of gastrointestinal stromal tumor patients, clinical manifestations are different. Among them had found 38 cases, accounted for 30.65% of the most common manifestations of physical examination; followed by abdominal discomfort (such as abdominal pain, abdominal distension) for 36 cases, accounting for 29.03%; bleeding again for the digestive tract (such as melena, hematemesis, hematochezia) for 17 cases, accounting for 13.71% a variety of clinical manifestations (such as abdominal pain; 浼翠究琛，

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