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目的探讨小肠间质瘤的诊断和治疗方法。方法回顾性分析32例空回肠间质瘤患者的临床资料。结果32例患者平均发病年龄52.8岁,病程10h至5年。主要临床表现为黑便、腹痛、腹部肿块、腹胀不适、发热、乏力、贫血、体重下降等。发生部位:空肠26例,回肠5例,空回肠多原发性1例。B超检查12例提示腹腔肿块,其中4例提示来源于肠道,5例不能提示来源,3例误诊为卵巢肿瘤。4例行消化道造影,均阴性。20例行CT检查,均发现肿瘤或转移病灶,阳性发现率100%,其中15例定位于肠道肿瘤(75.0%)。8例行数字减影血管造影(DSA),6例提示小肠肿瘤。5例行小肠镜检查,均明确诊断小肠肿瘤。所有患者均手术治疗。术后经病理及免疫组化证实为间质瘤。4例肝转移患者口服格列卫治疗。22例获得0.5～5年的随访,术后复发4例,肝转移2例,死亡2例。结论空回肠间质瘤缺乏特征性临床表现,CT和DSA对诊断有帮助,小肠镜诊断率高,手术及分子靶向治疗是其有效治疗方式。
Objective To investigate the diagnosis and treatment of intestinal stromal tumors. Methods The clinical data of 32 patients with ileal interstitial tumor were retrospectively analyzed. Results 32 patients with an average age of 52.8 years of age, duration of 10h to 5 years. The main clinical manifestations of melena, abdominal pain, abdominal mass, abdominal distension, fever, fatigue, anemia, weight loss and so on. Occurred parts: jejunum in 26 cases, ileum in 5 cases, multiple ileum in 1 case. B-ultrasound examination revealed 12 cases of abdominal mass, of which 4 cases prompted from the intestine, 5 cases can not prompt the source, 3 cases misdiagnosed as ovarian tumors. 4 routine gastrointestinal angiography, were negative. 20 cases of CT examination, were found tumor or metastatic lesions, the positive rate of 100%, of which 15 cases located in intestinal tumors (75.0%). 8 routine digital subtraction angiography (DSA), 6 cases of small bowel tumors. 5 cases of enteroscopy, were diagnosed with small bowel cancer. All patients were surgically treated. Postoperative pathological and immunohistochemical confirmed as stromal tumors. Four patients with liver metastases received oral Gleevec treatment. Twenty-two patients were followed up for 0.5-5 years. Four patients relapsed after operation, two patients had liver metastasis, and two patients died. Conclusion Ileum stromal tumor lacks characteristic clinical manifestations. CT and DSA are helpful in the diagnosis, and the diagnosis of enteroscopy is high. Surgery and molecular targeted therapy are effective treatments.