本文關(guān)鍵詞：124例胃腸道間質(zhì)瘤臨床診治分析　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 臨床特點(diǎn) 輔助檢查 診斷治療 預(yù)后分析

【摘要】：目的:通過對胃腸道間質(zhì)瘤患者發(fā)病的一般情況、臨床表現(xiàn)、各種輔助檢查的優(yōu)缺點(diǎn)、病理特征、診斷和治療方法、預(yù)后情況及預(yù)后影響因素的分析。給臨床診治及預(yù)后預(yù)測提供理論依據(jù),并促進(jìn)臨床醫(yī)生對該疾病早期診斷和治療水平的進(jìn)步,減少誤診和漏診。資料及方法:收集大連醫(yī)科大學(xué)附屬第一醫(yī)院2007年01月-2016年08月期間經(jīng)術(shù)后病理檢查確診的124例胃腸道間質(zhì)瘤患者的臨床病例資料;回顧性分析胃腸道間質(zhì)瘤患者的臨床資料,影像學(xué)檢查方式即X線鋇餐造影、內(nèi)鏡、EUS、MRI、MSCT、腹部B超等檢查結(jié)果。根據(jù)對患者的跟蹤隨訪,用單因素分析性別、年齡、腫瘤大小、部位、腫瘤有無轉(zhuǎn)移、腫瘤是否完整切除、核分裂象及術(shù)后是否行靶向治療與預(yù)后的關(guān)系。結(jié)果:(1)一般資料:統(tǒng)計(jì)了2007年01月至2016年8月期間大連醫(yī)科大學(xué)附屬第一醫(yī)院收治的均經(jīng)術(shù)后病理檢查確定為胃腸道間質(zhì)瘤患者124例,其中0-40歲患者占6例,41-60歲患者占52例,61-84歲患者占66歲,年齡最小患者為20歲,年齡最大患者為84歲,發(fā)病中位年齡為63歲。男性58例,女性66例,男女比例0.88:1。(2)臨床表現(xiàn):本組124例胃腸道間質(zhì)瘤患者中,臨床表現(xiàn)差異較大。其中最常見表現(xiàn)為體檢時(shí)無意中發(fā)現(xiàn)為38例,占30.65%;其次為腹部不適(如腹痛、腹脹)為36例,占29.03%;再次為消化道出血(如嘔血、黑便、便血)為17例,占13.71%;多種臨床表現(xiàn)(如腹痛伴便血)為12例,占9.68%;惡心、嘔吐、腹瀉為8例,占6.45%;腹部腫物5例,占4.03%;排便習(xí)慣改變、消瘦4例,占3.23%,其他臨床表現(xiàn)如吞咽困難、腸梗阻、腸穿孔等少見,總共4例,占3.23%。本組124例患者中,最常見發(fā)病部位為胃91例(73.39%)、其次為小腸17例(13.71%),十二指腸12例(9.68%),余食管、結(jié)腸、直腸、闌尾各一例。(3)輔助檢查:124例患者中,85例行CT檢查(平掃和或增強(qiáng)),檢出腹部腫物者共78例,檢出率91.76%,58例行內(nèi)鏡檢查(胃鏡或腸鏡),內(nèi)鏡直視下見到腫物者42例,檢出率為72.41%,12例患者行超聲檢查,發(fā)現(xiàn)腫物者8例,檢出率為66.67%,行EUS及MRI檢查者分別為12例及4例,檢出率均為100%。(4)治療方式:本文所研究的所有124例患者都經(jīng)過手術(shù)治療,其中經(jīng)外科手術(shù)治療的患者為121例,行根治性手術(shù)患者數(shù)119例,行姑息性手術(shù)患者數(shù)2例;內(nèi)鏡下切除治療的患者為3例。術(shù)后使用伊馬替尼分子靶向治療的患者7例。(5)病理及免疫組化:描述生物學(xué)行為的124例患者中,極低風(fēng)險(xiǎn)、低風(fēng)險(xiǎn)、中度風(fēng)險(xiǎn)、高風(fēng)險(xiǎn)所占例數(shù)分別為14例、60例、24例、26例。按腫瘤直徑2cm、2-5cm、5-10cm、10cm分組,所占例數(shù)及比例分別為25例(20.16%)、63例(50.81%)、25例(20.16%)、11例(8.87%)。全部124例病例術(shù)后病理及免疫組化均證實(shí)為GIST,其中CDll7(+)為119(95.97%),CD34(+)為106例(85.80%),S-100(+)為11例(8.87%),SMA(+)為19例(15.32%),Desmin(+)為9例(7.26%)。(6)隨訪:本研究124例患者中,共隨訪到89例,失訪35例,隨訪率為71.11%。隨訪時(shí)間最短為2個(gè)月,最長為108個(gè)月,中位隨訪時(shí)間45個(gè)月。在89例隨訪病例中,術(shù)后死亡病例為10例,其中男性4例,女性6例。術(shù)后生存時(shí)間5到95個(gè)月不等。對患者進(jìn)行生存結(jié)果分析顯示,GIST預(yù)后與手術(shù)方式的選擇(P=0.001)、腫瘤大小的差別(P=0.026)、術(shù)前腫瘤是否轉(zhuǎn)移(P0.001)有關(guān)系,差異具有統(tǒng)計(jì)學(xué)意義。結(jié)論:(1)GIST可發(fā)生于任何年齡,發(fā)病的中位年齡為63歲,40歲以前很少發(fā)病,男女發(fā)病率差異不明顯。(2)GIST的臨床表現(xiàn)紛繁多樣,輔助檢查缺乏特異性,術(shù)前診斷較為困難。確診主要依靠病理學(xué)及免疫組化檢查。(3)原發(fā)無轉(zhuǎn)移GIST患者的首選治療方式為手術(shù)治療,手術(shù)原則是是徹底切除病灶,保證切緣陰性,并且避免腫瘤破裂。(4)GIST預(yù)后與手術(shù)方式、腫瘤大小及術(shù)前腫瘤是否轉(zhuǎn)移有關(guān),差異具有統(tǒng)計(jì)學(xué)意義。
[Abstract]:Objective: through the general situation of gastrointestinal stromal tumor in the patients with clinical manifestations, advantages and disadvantages of various auxiliary examination, pathological features, diagnosis and treatment, analysis of prognostic factors and prognosis. To provide theoretical basis for clinical diagnosis and prognosis, and to promote the clinician to early diagnosis and treatment of the disease progress, reduce misdiagnosis and missed diagnosis. Materials and methods: -2016 during the 08 months of 2007 from the First Affiliated Hospital of Dalian Medical University after 01 months postoperative pathological examination diagnosed 124 cases of gastrointestinal stromal tumors in patients with clinical data; retrospective analysis of clinical data of patients with gastrointestinal stromal tumor, imaging methods X-ray radiography, endoscopy, EUS, MRI, MSCT, abdominal ultrasound examination results. According to the follow-up of the patients, with the single factor analysis of gender, age, tumor size, location, tumor metastasis, tumor Whether the relationship between complete resection, mitotic and postoperative targeted therapy and prognosis. Results: (1) general data: 2007 01 to August 2016 during the First Affiliated Hospital of Dalian Medical University were confirmed by postoperative pathological examination confirmed 124 cases of patients with gastrointestinal stromal tumor between statistics, which accounted for 0-40 years old patients in 6 cases, 41-60 years old accounted for 52 cases of patients, aged 61-84 patients accounted for 66 years old, the youngest patient was 20 years old, the maximum age of the patients was 84 years. The median age was 63 years old. 58 cases were male, 66 were female, male to female ratio of 0.88:1. (2) clinical manifestations: 124 cases of gastrointestinal stromal tumor patients, clinical manifestations are different. Among them had found 38 cases, accounted for 30.65% of the most common manifestations of physical examination; followed by abdominal discomfort (such as abdominal pain, abdominal distension) for 36 cases, accounting for 29.03%; bleeding again for the digestive tract (such as melena, hematemesis, hematochezia) for 17 cases, accounting for 13.71% a variety of clinical manifestations (such as abdominal pain; 浼翠究琛，

本文編號：1397453