CAJ | 학술논문

目的探讨十二指肠间质瘤的临床表现及外科治疗经验.方法回顾性分析中国医科大学附属第一医院1992年1月至2010年12月收治的39例十二指肠间质瘤的临床资料.结果本组十二指肠间质瘤的最常见症状为上消化道出血,占46％(18/39).增强CT是有效的诊断方法,准确率为69％(22/32),十二指肠镜检查的准确率为83％ (15/18).发病部位以十二指肠降部多见,占69％(27/39).39例均行手术治疗,R0切除34例,其中十二指肠部分切除术16例,胰十二指肠切除术12例,十二指肠节段切除术及胃大部切除术各3例,另有转流或探查手术5例.围手术期死亡1例,有9例出现术后并发症,均行非手术治疗治愈.R0切除术后患者1、3、5年生存率分别为90％、72％、41％.结论腹部增强CT和十二指肠镜检查是诊断十二指肠间质瘤的有效方法.根据十二指肠间质瘤的大小和位置采取不同的手术方式以达到R0切除,而十二指肠部分切除术应该是首选术式.对于中、高危险度的患者,术后应给予伊马替尼辅助治疗.
목적 탐토십이지장간질류적림상표현급외과치료경험.방법 회고성분석중국의과대학부속제일의원1992년1월지2010년12월수치적39례십이지장간질류적림상자료.결과 본조십이지장간질류적최상견증상위상소화도출혈,점46％(18/39).증강CT시유효적진단방법,준학솔위69％(22/32),십이지장경검사적준학솔위83％ (15/18).발병부위이십이지장강부다견,점69％(27/39).39례균행수술치료,R0절제34례,기중십이지장부분절제술16례,이십이지장절제술12례,십이지장절단절제술급위대부절제술각3례,령유전류혹탐사수술5례.위수술기사망1례,유9례출현술후병발증,균행비수술치료치유.R0절제술후환자1、3、5년생존솔분별위90％、72％、41％.결론 복부증강CT화십이지장경검사시진단십이지장간질류적유효방법.근거십이지장간질류적대소화위치채취불동적수술방식이체도R0절제,이십이지장부분절제술응해시수선술식.대우중、고위험도적환자,술후응급여이마체니보조치료.
Objective To investigate the clinical characteristics and surgical treatment of gastrointestinal stromal tumors (GIST) of the duodenum.Methods The clinical data of 39 patients with duodenal GISTs from 1992 to 2010 were analysed retrospectively.Results The most common symptoms of duodenal GISTs were alimentary tract hemorrhage,occuring in 18 cases of the 39 cases (46％).Clinical diagnosis established by CT in 22 cases (69％).Duodenoscopy performed in 18 cases established the definite diagnosis of GIST in 15 (83％).Duodenal GISTs were most commonly located in the descending portion of the duodenum in 27/39 cases (69％).All 39 cases received surgical treatment,with R0 resection in 34 cases,including partial resection of the duodenum in 47％ (16/34),pancreaticodenectomy in 35％(12/34),segmental resection of the duodenum in 3 cases,subtotal gastrectomy in 3 cases; One died perioperatively and postoperative complications developed in 9 cases,which were cured by conservative therapy.The 1,3,5 year survival rate was 90％,72％,41％ for those receiving R0 resection.Conclusions The abdominal CT scan with contrast and duodenoscopy are helpful to establish the diagnosis of duodenal GISTs.Surgical procedures depend on the size and site of the lesion for R0 resection.To decrease postoperative recurrence and prolong survival adjuvant therapy with Imatinib is necessary.