小肠间质瘤的临床特点及误诊分析

发布时间：2019-03-04 09:20

【摘要】：背景胃肠间质瘤(gastrointestinal stromal tumor,GIST)是一种起源于消化道的间叶源性肿瘤,组织学上富于梭形细胞、上皮样细胞、偶尔为多形性细胞,呈条束状、弥漫性排列;免疫表型上表达c-kit基因蛋白产物CD117。间质瘤细胞多由幼稚间充质细胞向卡哈尔间质细胞(interstitial cell of cajal,ICC)分化形成,诊断时易与平滑肌瘤和神经鞘膜瘤等疾病相混淆。临床上发病率相对较低,在消化道原发性肿瘤中仅占1%,中国目前缺乏完整的发病率资料。大部分GIST原发于胃,大约占总发病人数的50-65%,小肠是GIST的第二好发部位。发生于小肠的间质瘤统称为小肠间质瘤(small intestine stromal tumors,SIST),约占GIST的20%-35%,由于其发病率低、解剖部位隐匿、早期的临床症状不典型,临床上容易发生误诊,多误诊为妇科肿瘤、消化道平滑肌瘤等疾病。目前医学技术的发展使得GIST的生物学行为逐渐被人们所了解、熟悉,但国内外对SIST误诊因素方面研究相对较少,相关文献表明国内SIST发病率逐年升高,所以探究其临床特点及误诊因素以减少误诊率有重要意义。目的本研究通过运用统计学理念及方法来回顾性分析SIST患者的临床数据资料,探讨SIST的临床特点及引起误诊的因素,以提高对其诊治水平,减少误诊的发生。方法本研究收集了104例于2010年1月至2015年1月期间在郑州大学第一附属医院住院的SIST病人的完整病历资料,所有患者均经病理检测确诊为SIST。回顾性分析其临床表现、肿瘤部位、肿瘤大小、生长方式、检查方式等方面的临床数据资料,把所有患者分成确诊组和误诊组进行统计描述,应用SPSS19.0统计软件进行数据分析,分析在不同因素时SIST误诊情况。计量资料用mean±SD进行描述,两组间比较采用独立样本t检验,将对SIST发生误诊的影响因素纳入二分类Logistic回归模型进行分析,评估每个变量与是否发生误诊之间的关系。P0.05为差异具有统计学意义。结果SIST发病部位以空肠多见,占45.2%,其次是回肠(29.8%)、十二指肠(25%);临床症状以腹部包块67例(64.5%)、消化道出血47例(52.8%)、腹痛47例(52.8%)为主;腔外型生长是SIST最多见的生长方式;肿瘤直径10cm占87例(83.6%),其中5cm占49例;消化内镜检查在诊断时起重要作用,彩超检查最易发生误诊;转移部位以肝脏为主,少数出现腹膜、淋巴结、骨转移等。本研究中该病误诊率高达34.6%,易误诊为妇科肿瘤(15/36)、消化道平滑肌瘤(3/36)等疾病。结论SIST是多发于空肠且以腹部包块、消化道出血等为常见临床表现的胃肠道间质瘤,其临床误诊率较高,其是否发生误诊受临床表现、肿瘤部位、肿瘤直径大小、生长方式、检查方法等因素影响。对于彩超、CT、普通胃肠镜等反复检查不能明确诊断的持续性消化道出血、腹部包块、长期中上腹疼痛的患者应及时行小肠镜或胶囊内镜检查。尽早行活检及免疫组化等检查,以便早期诊断,避免误诊。
[Abstract]:Background Gastrointestinal stromal tumor (gastrointestinal stromal tumor,GIST) is a mesenchymal tumor originating from the digestive tract. Histologically it is rich in spindle-like cells, epithelial-like cells, occasionally pleomorphic cells, in a banded, diffuse arrangement. Expression of c-kit Gene protein Product CD117. on Immunophenotype Mesenchymal tumor cells are mostly differentiated from immature mesenchymal cells to Kakhar stromal cells (interstitial cell of cajal,ICC), which may be confused with leiomyoma and neurilemmoma in diagnosis. The clinical incidence is relatively low, accounting for only 1% of primary gastrointestinal tumors, and there is no complete incidence data in China. Most of GIST is primarily located in the stomach, accounting for about 50% of the total incidence of GIST, and the small intestine is the second most common site of the disease. Stromal tumor of small intestine is called small intestinal stromal tumor (small intestine stromal tumors,SIST), which accounts for 20% of GIST. Because of its low incidence, hidden anatomic site and atypical early clinical symptoms, it is easy to be misdiagnosed in clinic. Most misdiagnosed as gynecological tumors, digestive tract leiomyoma and other diseases. At present, with the development of medical technology, the biological behavior of GIST is gradually known and familiar. However, there are relatively few studies on misdiagnosed factors of SIST at home and abroad. The related literatures indicate that the incidence of SIST in China is increasing year by year. Therefore, it is of great significance to explore its clinical characteristics and misdiagnosis factors in order to reduce the rate of misdiagnosis. Objective in order to improve the diagnosis and treatment of SIST and reduce the occurrence of misdiagnosis, the clinical data of patients with SIST were analyzed retrospectively by using statistical theory and method, and the clinical characteristics and the factors causing misdiagnosis were discussed in order to improve the level of diagnosis and treatment. Methods the complete medical records of 104 SIST patients admitted to the first affiliated Hospital of Zhengzhou University from January 2010 to January 2015 were collected. All patients were diagnosed as SIST. by pathological examination. The clinical data of clinical manifestation, tumor location, tumor size, growth pattern and examination mode were analyzed retrospectively, and all patients were divided into two groups: diagnosed group and misdiagnosed group, and all the patients were divided into diagnostic group and misdiagnosed group for statistical description. The data were analyzed by SPSS19.0 software, and the misdiagnosis of SIST in different factors was analyzed. The measurement data were described by mean 卤SD. The independent sample t-test was used to compare the two groups. The influencing factors of misdiagnosis of SIST were analyzed by binary Logistic regression model. To evaluate the relationship between each variable and whether misdiagnosis occurred. P0.05 was statistically significant. Results the most common sites of SIST were jejunum (45.2%), ileum (29.8%) and duodenum (25%). The main clinical symptoms were abdominal mass in 67 cases (64.5%), gastrointestinal bleeding in 47 cases (52.8%), abdominal pain in 47 cases (52.8%), extraluminal growth was the most common growth mode of SIST. 10cm in diameter was found in 87 cases (83.6%), of which 49 cases were 5cm, endoscopy played an important role in diagnosis, and color Doppler ultrasonography was most likely to misdiagnose, liver was the main metastatic site, peritoneum, lymph node and bone metastasis were found in a few cases. In this study, the misdiagnosis rate was 34.6%. It was easy to be misdiagnosed as gynecological tumor (15 / 36) and gastrointestinal leiomyoma (3 / 36). Conclusion SIST is a common clinical manifestation of gastrointestinal stromal tumors in jejunum, abdominal mass, gastrointestinal bleeding, and so on. Its misdiagnosis rate is high, whether it is misdiagnosed by clinical manifestations, tumor location, tumor diameter, growth pattern, and so on. The method of examination and other factors. The patients with persistent gastrointestinal bleeding, abdominal mass and long-term upper abdominal pain who cannot be diagnosed by color Doppler ultrasonography, CT, ordinary gastroscopy and other repeated examinations should be examined by enteroscopy or capsule endoscopy in time. Biopsy and immunohistochemistry were performed as early as possible in order to diagnose early and avoid misdiagnosis.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.32

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