本文關(guān)鍵詞：胃腸道間質(zhì)瘤伴肺轉(zhuǎn)移一例病例報道及文獻(xiàn)回顧　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 胃腸道間質(zhì)瘤 肺轉(zhuǎn)移 病例報道 文獻(xiàn)回顧

【摘要】：目的:胃腸道間質(zhì)瘤(Gastrointestinal stromal tumors,GIST)是消化系統(tǒng)比較常見的一種間葉組織來源的實體腫瘤,肝臟和腹膜轉(zhuǎn)移是其主要的轉(zhuǎn)移部位,發(fā)生肺轉(zhuǎn)移在臨床上是實屬罕見的。本文通過分析大連醫(yī)科大學(xué)附屬第一醫(yī)院腹部急癥外科所收治的一例小腸間質(zhì)瘤伴肺轉(zhuǎn)移的病例資料,并結(jié)合國內(nèi)外相關(guān)文獻(xiàn)來探討胃腸道間質(zhì)瘤伴肺轉(zhuǎn)移的臨床表現(xiàn)特點、診斷、治療方法及預(yù)后情況,指導(dǎo)臨床治療。方法:通過分析2009年2月-2015年3月期間大連醫(yī)科大學(xué)附屬第一醫(yī)院腹部急癥外科收治的一例小腸間質(zhì)瘤伴肺轉(zhuǎn)移病人的臨床資料,并結(jié)合相關(guān)國內(nèi)外文獻(xiàn)報道的5例胃腸道間質(zhì)瘤伴肺轉(zhuǎn)移病人的臨床資料,進(jìn)行回顧性分析和總結(jié)胃腸道間質(zhì)瘤伴肺轉(zhuǎn)移的臨床特點、影像學(xué)表現(xiàn)、病理學(xué)及免疫組織化學(xué)特征、治療方法與預(yù)后情況。結(jié)果:本院所收治的一例小腸間質(zhì)瘤伴肺轉(zhuǎn)移的患者入院后完善相關(guān)輔助檢查,患者術(shù)臨床診斷為小腸腫瘤。術(shù)中見腹腔內(nèi)腫物實性,包膜完整,大小15×15cm,切開腫物質(zhì)白色,腫物位于小腸壁,距盲腸約20cm,遠(yuǎn)端小腸及結(jié)腸內(nèi)可見大量血液,術(shù)中距腫物10cm行小腸部分切除(含腫物)。術(shù)中診斷為小腸間質(zhì)瘤合并出血。術(shù)后病理回報:小腸間質(zhì)瘤(高風(fēng)險),腸管兩側(cè)手術(shù)切緣均為陰性。術(shù)后免疫組織化學(xué)檢查結(jié)果為:CD117(+),CD34(-)。術(shù)后患者恢復(fù)良好,建議患者口服分子靶向藥物甲磺酸伊馬替尼進(jìn)行輔助治療,但患者及家屬因經(jīng)濟(jì)原因拒絕了藥物輔助治療。術(shù)后囑患者每隔半年來我院復(fù)查一次,術(shù)后第4年,患者又因腹部不適伴咯血再次入院,復(fù)查胸腹部CT和腹部CT考慮為小腸間質(zhì)瘤術(shù)后復(fù)發(fā)伴肺內(nèi)及肝內(nèi)轉(zhuǎn)移。患者因發(fā)生肺轉(zhuǎn)移,且復(fù)發(fā)腫瘤較大,手術(shù)無法完整切除,因此建議患者口服分子靶向藥物甲磺酸伊馬替尼進(jìn)行治療,定期隨訪。隨訪至今2016年,患者身體狀況良好,復(fù)發(fā)和轉(zhuǎn)移病灶明顯縮小。通過筆者大量查閱文獻(xiàn),目前國內(nèi)外總共報道了5例胃腸道間質(zhì)瘤伴肺轉(zhuǎn)移的患者,這5位患者發(fā)病平均年齡53.4歲,有4名男性患者和1名女性患者。術(shù)前影像學(xué)檢查和術(shù)中探查,能夠較準(zhǔn)確地判斷腫瘤的大小、侵襲生長和遠(yuǎn)處轉(zhuǎn)移情況。其中,有三個患者確診后接受了手術(shù)完整切除,有兩個患者確診后全程接受了藥物治療。文獻(xiàn)報道的這5例胃腸道間質(zhì)瘤伴肺轉(zhuǎn)移的患者中,均伴有其他遠(yuǎn)處器官的轉(zhuǎn)移,有兩例是分別術(shù)后5年和10年才發(fā)現(xiàn)遠(yuǎn)處肺轉(zhuǎn)移,其余3例首次確診時就已經(jīng)發(fā)現(xiàn)有肺轉(zhuǎn)移。病理以及免疫組織化學(xué)檢查是診斷胃腸道間質(zhì)瘤的金標(biāo)準(zhǔn),這5例患者病理免疫組織化學(xué)檢查CD117表達(dá)均為陽性,有3例CD34表達(dá)陽性,。5例患者確診后均接受了分子靶向藥物伊馬替尼治療,確診后分別隨訪5年至10年不等,患者的臨床癥狀都得到了部分緩解。結(jié)論:胃腸間質(zhì)瘤患者發(fā)生肺轉(zhuǎn)移在臨床上是非常罕見的,臨床癥狀不典型,生物學(xué)行為比較復(fù)查,在臨床上很難準(zhǔn)確預(yù)測,良性和潛在惡性腫瘤者也可復(fù)發(fā)及轉(zhuǎn)移,診斷主要依靠影像學(xué)、術(shù)后病理檢查及免疫組織化學(xué)檢測。首診為腹腔內(nèi)及肺轉(zhuǎn)移患者,一般為病程晚期,失去手術(shù)最佳時機(jī),但確診后給予全程分子靶向藥物伊馬替尼治療,能明顯緩解患者預(yù)后及改善生活質(zhì)量。
[Abstract]:Objective: gastrointestinal stromal tumor (Gastrointestinal stromal, tumors, GIST) is a kind of digestive system common mesenchymal tumors, liver and peritoneal metastasis is the main metastatic site, lung metastasis is rare in clinic. In this paper, through the analysis of Dalian Medical University First Affiliated Hospital of the acute abdomen surgery from a case of small intestinal stromal tumor with lung metastasis cases, combined with the related literature at home and abroad to discuss gastrointestinal stromal tumors with clinical features of lung metastasis, diagnosis, treatment and prognosis and guiding clinical treatment. Methods: through the analysis of February 2009 -2015 year in March in the First Affiliated Hospital of Dalian Medical University during the period of acute abdomen from a case of small intestinal stromal tumor with lung metastasis in patients with clinical data, combined with relevant literatures of 5 cases of gastrointestinal stromal tumors with metastatic lung disease The clinical data, were retrospectively analyzed and summarized gastrointestinal stromal tumors with clinical features of lung metastasis, imaging findings, pathological and immunohistochemical features, treatment methods and prognosis. Results: the hospital treated a case of intestinal stromal tumor with lung metastasis of the patients after admission to improve the relevant auxiliary examination, clinical diagnosis of patients with small bowel tumors. Intraoperative findings of intra-abdominal mass solid, capsule integrity, size 15 * 15cm, and the tumor is white, tumors located at about 20cm away from the wall of the small intestine, cecum, colon and distal small intestine showed a large amount of blood, intraoperative tumor from 10cm for partial small bowel resection (including tumor). Intraoperative diagnosis of small intestinal stromal tumor with bleeding. Postoperative pathology: gastrointestinal stromal tumors of the small intestine (high risk), on both sides of the surgical margins were negative. The immunohistochemical examination results: CD117 (+), CD34 (-). Postoperative patients recovered well and advise patients Oral targeted drug imatinib adjuvant therapy, but the patients and their families because of economic reasons refused treatment. Postoperative patients every six months in our hospital review once, fourth years after surgery, patients with abdominal discomfort associated with hemoptysis readmission, review thoracic abdominal CT and abdominal CT considering the small intestinal stromal tumor recurrence with lung and liver metastasis. Patients with lung metastasis, and recurrence of larger tumors, surgery can not complete resection, therefore suggested oral molecules in patients with targeted drug imatinib mesylate treatment, regular follow-up to 2016 this year, the physical condition of patients, recurrence and metastasis the lesion was significantly reduced. The author through a lot of literature at home and abroad, a total of 5 reported cases of gastrointestinal stromal tumor with lung metastasis patients, the 5 patients with an average age of 53.4 years, 4 male patients and 1 female patients. Exploration of examination and preoperative imaging can accurately determine the tumor size, tumor growth and metastasis. Among them, three patients underwent complete resection, two patients diagnosed after full acceptance of the drugs. The reported 5 cases of gastrointestinal stromal tumor with lung the transfer of patients, metastasis were associated with other distant organs, two cases was 5 years and 10 years respectively after surgery found pulmonary metastasis, the remaining 3 cases were first diagnosed when they have been found to have lung metastasis. The pathological and immunohistochemical examination is the gold standard for diagnosis of gastrointestinal stromal tumors, 5 cases of this patients with pathological immunohistochemistry to examine the expression of CD117 was positive in 3 cases, the positive expression of CD34,.5 patients were diagnosed after received imatinib mesylate treatment after diagnosis were followed up for 5 years to 10 years, the clinical symptoms of the patients have to part Divided into remission. Conclusion: Patients with gastrointestinal stromal tumor pulmonary metastasis in clinic is very rare and atypical clinical symptoms, comparative review of clinical biological behavior, it is difficult to accurately predict benign and potential malignant tumor can recurrence and metastasis, the diagnosis mainly depends on imaging, pathological examination and immunohistochemistry after surgery. A first diagnosis of abdominal cavity and lung metastasis patients, usually late in the course of the disease the best time, without surgery, but after diagnosis given the whole molecular targeted drug imatinib therapy, can alleviate the quality of life and improve the prognosis of patients.

【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735

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本文編號：1379564