CAJ | 학술논문

目的总结十二指肠间质瘤的诊断和外科治疗经验.方法回顾性分析1999年5月至2013年3月我院诊治的29例十二指肠间质瘤病例资料.结果 29例患者主要临床表现为黑便、中上腹不适或腹痛.术前诊断主要依据影像学和内镜检查,但活检准确率低.内镜超声引导下细针穿刺活检有助于明确诊断.29例患者均完整切除肿瘤.其中13例行胰十二指肠切除；11例行肿瘤局部切除；5例行十二指肠节段切除.术后7例服用伊马替尼.术后随访2～118个月,平均48.2个月.26例患者存活至今.其中23例无复发或转移征象；4例出现肝脏转移；2例肿瘤复发.核分裂相≥5/50高倍视野(HPF)为术后复发转移的高危因素.结论十二指肠间质瘤首选手术切除,根据肿瘤大小和位置选择合理的手术方式.早期诊断和完整切除肿瘤对改善预后至关重要.肿瘤破裂或高危患者术后应给予口服伊马替尼辅助治疗.
목적 총결십이지장간질류적진단화외과치료경험.방법 회고성분석1999년5월지2013년3월아원진치적29례십이지장간질류병례자료.결과 29례환자주요림상표현위흑편、중상복불괄혹복통.술전진단주요의거영상학화내경검사,단활검준학솔저.내경초성인도하세침천자활검유조우명학진단.29례환자균완정절제종류.기중13례행이십이지장절제；11례행종류국부절제；5례행십이지장절단절제.술후7례복용이마체니.술후수방2～118개월,평균48.2개월.26례환자존활지금.기중23례무복발혹전이정상；4례출현간장전이；2례종류복발.핵분렬상≥5/50고배시야(HPF)위술후복발전이적고위인소.결론 십이지장간질류수선수술절제,근거종류대소화위치선택합리적수술방식.조기진단화완정절제종류대개선예후지관중요.종류파렬혹고위환자술후응급여구복이마체니보조치료.
Objective To review our experience in the diagnosis and surgical treatment of duodenal gastrointestinal stromal tumor (GIST).Methods A retrospective study was conducted on 29 patients with duodenal GISTs diagnosed and treated in our hospital between May 1999 and March 2013.Results The clinical symptoms included melaena,and upper abdominal discomfort or pain.The preoperative diagnosis depended on imaging and endoscopy,but tumour biopsy had a low accuracy.Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) helped to confirm the diagnosis in some patients.All these patients received curative surgical resection successfully.The operations included 13 pancreaticoduodenectomy,11 local duodenal resections and 5 segmental duodenectomy.Imatinib was given to 7 patients postoperatively.At a mean follow-up of 48.2 months (range 2-118),23 patients were alive with no evidence of recurrence or metastasis.Four patients had developed liver metastasis,and two patients had developed tumor recurrence.A Mitotic count ≥5/50 high-power field (HPF) was a risk factor of post-operative recurrence and metastasis.Conclusions Surgical resection is the best treatment for duodenal GIST.The optimal surgery depends on the tumor size and location.Early diagnosis and complete tumor resection are important for a good prognosis.Patients with tumor rupture or high risk grading should be given imatinib therapy postoperatively.