胃肠道间质瘤32例回顾性研究并文献复习

发布时间：2018-04-15 05:01

本文选题：胃肠道间质瘤 + 回顾性研究　；参考：《兰州大学》2017年硕士论文

【摘要】：目的:通过对胃肠道间质瘤的临床特点、组织学类型、手术方式、诊治经验等进行回顾性研究,以提高胃肠道间质瘤的认识及诊治水平。方法:回顾性分析我院收治的行手术治疗的32例胃肠道间质瘤病人的临床资料,同时结合纳入的89篇文献,对其临床特点、病理、诊断、治疗以及预后等进行统计学描述,并分析整理相关临床资料。结果:32名患者中,19名女性患者,13名男性患者,女:男=1.46:1,年龄:19-83岁,平均:(56.00±14.438)岁,所有患者术后均经病理及免疫组化CD117及CD34确诊。32例GISTs原发部位:27例原发胃部,2例在小肠,3例原发胃肠道外(1例原发小网膜,1例原发小肠系膜,1例原发部位在腹膜后);组织类型中:梭形、混合细胞型分别为30例、2例;肿瘤直径:2-15cm,平均:(5.94±3.441)cm,5cm:16例,5-10cm:13例,10cm:3例;肿瘤性坏死:9例;极低危险度1例,低危11例,中危9例,高危11例;25例出现腹部不适,14例出现呕血、黑便,1例腹部扪诊到包块,1例行体格检查时发现;辅助检查:32例行CT检查,18例行胃镜检查,16例行超声内镜检查。实验室检测:10例潜血试验阳性,9例血红蛋白下降,2例白蛋白下降,10例肿瘤标志物升高。对25例病患进行了术中出血量的统计,出血量:10-800ml,平均:(139.60±177.752)ml。肿瘤大小、核分裂数多少、肿瘤不同原发部位及Ki67指数不同在肿瘤危险度分级比较中具有统计学意义(P0.05)。手术方式不同在术后住院时间的比较中不具有统计学意义(P0.05)。CD117检测:31例阳性(96.9%),1例阴性(3.1%);CD34检测:28例阳性(87.5%),4例阴性(12.5%);DOG1检测:4例阴性(12.5%),28例阳性(87.5%)。纳入89篇文献报道4737例患者,男:女=1.10:1,就诊时间1985年4月-2016年3月,年龄:15-87岁。GISTs原发部位:食管所占百分比(1.1%),胃所占百分比(71.9%),小肠所占百分比(19.8%),结直肠所占百分比(3.5%),胃肠道外百分比(3.6%)。4737例患者均经病理检查诊断为间质瘤。结论:早期发现胃肠道间质瘤相对困难,完整的手术切除仍是目前最佳的治疗手段,对于中、高危人群,应同时辅以分子靶向药物治疗。
[Abstract]:Objective: to improve the understanding and diagnosis of gastrointestinal stromal tumors (GIST) by retrospective study of clinical features, histological types, surgical methods, diagnosis and treatment experience.Methods: the clinical data of 32 patients with gastrointestinal stromal tumors treated by surgery in our hospital were analyzed retrospectively. The clinical features, pathology, diagnosis, treatment and prognosis were analyzed statistically.The clinical data were analyzed and analyzed.Results of the 32 patients, 19 were female and 13 were male. Female: male 1.46: 1, age: 19 to 83, average age: 56.00 卤14.438.All patients were diagnosed by pathological and immunohistochemical CD117 and CD34. 32 cases of GISTs were diagnosed as primary site: 27 cases of primary gastric carcinoma 2 cases of primary stomach in 3 cases of primary gastrointestinal tract and 1 case of primary omentum omentum in 1 case of primary mesentery of small intestine in the peritoneum of 1 case.In the type of tissue: fusiform,There were 30 cases of mixed cell type, 2 cases of mixed cell type, 2 cases of tumor diameter: 2-15 cm, mean diameter of 5: 94 卤3.441 cm + 5 cm%, 16 cases of 5-10 cm: 13 cases, 13 cases of tumor necrosis, 9 cases of tumor necrosis, 1 case of very low risk, 11 cases of low risk, 9 cases of moderate risk, 14 cases of abdominal discomfort, 14 cases of high risk, 14 cases of abdominal discomfort, 14 cases of high risk.In 1 case with black stool, 1 case with abdominal palpation was diagnosed as mass, 1 case was found with physical examination, 32 cases with CT examination, 18 cases with gastroscopy and 16 cases with endoscopic ultrasonography.In the laboratory, 10 cases of occult blood test were detected. 9 cases of hemoglobin decreased and 2 cases of albumin decreased. 10 cases of tumor markers were elevated.The intraoperative bleeding volume of 25 patients was estimated to be 10 ~ (-800) ml, with an average of 139.60 卤177.752 ml 路min ~ (-1).The size of the tumor, the number of mitotic cells, the different primary sites of the tumor and the Ki67 index were statistically significant in the comparison of tumor risk grade (P 0.05).There was no statistical significance in the comparison of postoperative hospitalization time between the two groups. There was no statistical significance in the comparison of postoperative hospitalization time. There were 31 cases with positive rate of 96. 9% and 1 case with negative rate of 3. 1%. CD34 was detected in 8: 28 cases with positive rate of 87.5% and 4 cases with negative 12. 5% DOG 1. In 4 cases, there were 12. 528 cases with negative 12. 5% and 12. 5% with positive value of 87.55.The results showed that there was no significant difference between the two groups (P 0. 05, P < 0. 05).A total of 4737 patients (male: female 1.10: 1) were included in 89 literature reports. The time of consultation was April 1985-March 2016.Age 15-87 years old. GISTs primary site: the percentage of esophagus is 1.1%, the percentage of stomach is 71.9%, the percentage of small intestine is 19.881%, the percentage of colon and rectum is 3.55.The percentage of gastrointestinal tract is 3.60.4737 cases are diagnosed as stromal tumors by pathological examination.Conclusion: early detection of gastrointestinal stromal tumors is relatively difficult, complete surgical resection is still the best treatment, for middle and high risk population, should be supplemented with molecular targeted drug treatment.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735

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