本文選題：胃腸道間質(zhì)瘤　切入點：臨床特點　出處：《山西醫(yī)科大學》2017年碩士論文

【摘要】：目的:綜合分析375例胃腸道間質(zhì)瘤(Gastrointestinal Stromal Tumors GISTs)的發(fā)病特點、影像學表現(xiàn)、病理特征、治療及預后因素,以提高對該疾病的臨床認識及診療水平。方法:收集山西省腫瘤醫(yī)院及我院2010年1月至2016年8月期間收治的375例經(jīng)病理確診為胃腸道間質(zhì)瘤患者的病例資料,回顧性分析這些患者的發(fā)病年齡、性別、臨床表現(xiàn)、影像學檢查、腫瘤部位及大小、浸潤深度、病理表現(xiàn)、轉(zhuǎn)移及治療方式,并通過隨訪了解其預后情況,分析影響GISTs預后的相關(guān)因素。結(jié)果:(1)共375例患者納入本組研究,其中男性178例,女性197例;中位發(fā)病年齡為58歲,年齡最小者23歲,最大者85歲。(2)臨床表現(xiàn)多不典型,常見臨床表現(xiàn)為腹部不適、消化道出血、腹部包塊及腫瘤壓迫等相關(guān)癥狀,偶可因急腹癥或腫瘤合并感染就診。體檢或偶然發(fā)現(xiàn)者占16.27%。(3)本病可通過消化道造影、腹部彩超、CT及MRI、超聲內(nèi)鏡等檢查初步了解腫瘤的一般情況,但確診依賴于病理,鏡下GISTs細胞形態(tài)差異明顯,惡性程度高的腫瘤邊界多不清晰,直接浸潤或與周圍組織炎性粘連。(4)本組腫瘤大小不一,最小者0.3cm,最大者33cm;其中腫瘤直徑10cm者占19.2%,均為高度危險組。(5)GISTs多原發(fā)于胃腸道,常見發(fā)病部位依次為胃小腸結(jié)直腸食管GIST,胃腸道外GISTs較少見。對本組原發(fā)于胃腸道不同部位GISTs的生物學分析及比較可知,小腸GISTs比胃GISTs更容易浸潤漿膜及發(fā)生遠處轉(zhuǎn)移,差異有統(tǒng)計學意義(P0.05),而食管和胃GISTs的生物學行為差異不顯著(P0.05)。(6)本組375例病理資料示梭形細胞瘤272例(72.5%),上皮細胞瘤61例(16.3%),混合細胞型42例(11.2%);核分裂數(shù):≤5/50HPF 228例(60.8%),5/50HPF 147例(39.2%)。免疫組化示CD117陽性率95.73%,CD34陽性率69.9%,DOG-1陽性率93.6%。(7)不同部位腫瘤與NIH分級、Miettinen分級均有統(tǒng)計學意義(P0.05),NIH分級較Miettinen分級更能評估預后情況。(8)GISTs患者的預后受多因素影響。單因素顯示腫瘤大小、腫瘤部位、是否轉(zhuǎn)移、Ki-67、核分裂數(shù)、NIH分級、Miettinen分級及手術(shù)方式這8項因素對預后有統(tǒng)計學意義(P0.05);多因素顯示是否轉(zhuǎn)移及手術(shù)方式與預后密切相關(guān),可能為預后獨立危險因素。結(jié)論:GISTs多見于中老年人,臨床表現(xiàn)不典型,具有惡性傾向,確診依賴于病理活檢,臨床特點、危險度分級可大致預測預后情況,早期發(fā)現(xiàn)及診治仍是改善預后的重要著手點,手術(shù)治療是GISTs的一線治療手段,對術(shù)后復發(fā)或轉(zhuǎn)移者,可給予靶向藥物輔助治療提高生存率。
[Abstract]:Objective: to analyze the pathogenetic features, imaging features, pathological features, treatment and prognostic factors of Gastrointestinal Stromal Tumors GISTs in 375 cases. Methods: 375 cases of gastrointestinal stromal tumors (GIST) were collected from Shanxi Cancer Hospital and our hospital from January 2010 to August 2016. The age, sex, clinical manifestation, imaging examination, tumor location and size, depth of invasion, pathological manifestation, metastasis and treatment of these patients were retrospectively analyzed. Results: a total of 375 patients (178 males and 197 females) were included in the study. The median age of onset was 58 years old, the youngest was 23 years old, the oldest was 85 years old. The common clinical manifestations are abdominal discomfort, gastrointestinal hemorrhage, abdominal mass and tumor compression. The CT, MRI and endoscopic examination of abdominal color Doppler ultrasound were used to understand the general situation of the tumor, but the diagnosis depended on pathology. The morphologic difference of GISTs cells was obvious under the microscope, and the boundary of the tumor with high malignancy degree was not clear. The tumor size varied from 0.3 cm to 33 cm, in which the diameter of tumor was 19.2cm, and most of them were primary gastrointestinal tract in high risk group. The most common sites were gastroenteric colorectal esophagus (GIST) and gastrointestinal GISTs. The biological analysis and comparison of GISTs in different parts of gastrointestinal tract showed that small intestinal GISTs was more likely to infiltrate serosa and distant metastasis than gastric GISTs. The difference was statistically significant (P 0.05), but there was no significant difference in the biological behavior of GISTs between esophagus and stomach (P 0.05. 6) the pathological data of 375 cases showed that 272 cases of spindle cell tumor, 61 cases of epithelial cell tumor, 42 cases of mixed cell type were involved in 72.5%, 16. 3%, and 42 cases of mixed cell type respectively. Mitotic number: 鈮，

本文編號：1700022