本文選題：胃腸道間質瘤 + 回顧性研究�。� 參考：《蘭州大學》2017年碩士論文

【摘要】：目的:通過對胃腸道間質瘤的臨床特點、組織學類型、手術方式、診治經驗等進行回顧性研究,以提高胃腸道間質瘤的認識及診治水平。方法:回顧性分析我院收治的行手術治療的32例胃腸道間質瘤病人的臨床資料,同時結合納入的89篇文獻,對其臨床特點、病理、診斷、治療以及預后等進行統(tǒng)計學描述,并分析整理相關臨床資料。結果:32名患者中,19名女性患者,13名男性患者,女:男=1.46:1,年齡:19-83歲,平均:(56.00±14.438)歲,所有患者術后均經病理及免疫組化CD117及CD34確診。32例GISTs原發(fā)部位:27例原發(fā)胃部,2例在小腸,3例原發(fā)胃腸道外(1例原發(fā)小網膜,1例原發(fā)小腸系膜,1例原發(fā)部位在腹膜后);組織類型中:梭形、混合細胞型分別為30例、2例;腫瘤直徑:2-15cm,平均:(5.94±3.441)cm,5cm:16例,5-10cm:13例,10cm:3例;腫瘤性壞死:9例;極低危險度1例,低危11例,中危9例,高危11例;25例出現腹部不適,14例出現嘔血、黑便,1例腹部捫診到包塊,1例行體格檢查時發(fā)現;輔助檢查:32例行CT檢查,18例行胃鏡檢查,16例行超聲內鏡檢查。實驗室檢測:10例潛血試驗陽性,9例血紅蛋白下降,2例白蛋白下降,10例腫瘤標志物升高。對25例病患進行了術中出血量的統(tǒng)計,出血量:10-800ml,平均:(139.60±177.752)ml。腫瘤大小、核分裂數多少、腫瘤不同原發(fā)部位及Ki67指數不同在腫瘤危險度分級比較中具有統(tǒng)計學意義(P0.05)。手術方式不同在術后住院時間的比較中不具有統(tǒng)計學意義(P0.05)。CD117檢測:31例陽性(96.9%),1例陰性(3.1%);CD34檢測:28例陽性(87.5%),4例陰性(12.5%);DOG1檢測:4例陰性(12.5%),28例陽性(87.5%)。納入89篇文獻報道4737例患者,男:女=1.10:1,就診時間1985年4月-2016年3月,年齡:15-87歲。GISTs原發(fā)部位:食管所占百分比(1.1%),胃所占百分比(71.9%),小腸所占百分比(19.8%),結直腸所占百分比(3.5%),胃腸道外百分比(3.6%)。4737例患者均經病理檢查診斷為間質瘤。結論:早期發(fā)現胃腸道間質瘤相對困難,完整的手術切除仍是目前最佳的治療手段,對于中、高危人群,應同時輔以分子靶向藥物治療。
[Abstract]:Objective: to improve the understanding and diagnosis of gastrointestinal stromal tumors (GIST) by retrospective study of clinical features, histological types, surgical methods, diagnosis and treatment experience.Methods: the clinical data of 32 patients with gastrointestinal stromal tumors treated by surgery in our hospital were analyzed retrospectively. The clinical features, pathology, diagnosis, treatment and prognosis were analyzed statistically.The clinical data were analyzed and analyzed.Results of the 32 patients, 19 were female and 13 were male. Female: male 1.46: 1, age: 19 to 83, average age: 56.00 鹵14.438.All patients were diagnosed by pathological and immunohistochemical CD117 and CD34. 32 cases of GISTs were diagnosed as primary site: 27 cases of primary gastric carcinoma 2 cases of primary stomach in 3 cases of primary gastrointestinal tract and 1 case of primary omentum omentum in 1 case of primary mesentery of small intestine in the peritoneum of 1 case.In the type of tissue: fusiform,There were 30 cases of mixed cell type, 2 cases of mixed cell type, 2 cases of tumor diameter: 2-15 cm, mean diameter of 5: 94 鹵3.441 cm + 5 cm%, 16 cases of 5-10 cm: 13 cases, 13 cases of tumor necrosis, 9 cases of tumor necrosis, 1 case of very low risk, 11 cases of low risk, 9 cases of moderate risk, 14 cases of abdominal discomfort, 14 cases of high risk, 14 cases of abdominal discomfort, 14 cases of high risk.In 1 case with black stool, 1 case with abdominal palpation was diagnosed as mass, 1 case was found with physical examination, 32 cases with CT examination, 18 cases with gastroscopy and 16 cases with endoscopic ultrasonography.In the laboratory, 10 cases of occult blood test were detected. 9 cases of hemoglobin decreased and 2 cases of albumin decreased. 10 cases of tumor markers were elevated.The intraoperative bleeding volume of 25 patients was estimated to be 10 ~ (-800) ml, with an average of 139.60 鹵177.752 ml 路min ~ (-1).The size of the tumor, the number of mitotic cells, the different primary sites of the tumor and the Ki67 index were statistically significant in the comparison of tumor risk grade (P 0.05).There was no statistical significance in the comparison of postoperative hospitalization time between the two groups. There was no statistical significance in the comparison of postoperative hospitalization time. There were 31 cases with positive rate of 96. 9% and 1 case with negative rate of 3. 1%. CD34 was detected in 8: 28 cases with positive rate of 87.5% and 4 cases with negative 12. 5% DOG 1. In 4 cases, there were 12. 528 cases with negative 12. 5% and 12. 5% with positive value of 87.55.The results showed that there was no significant difference between the two groups (P 0. 05, P < 0. 05).A total of 4737 patients (male: female 1.10: 1) were included in 89 literature reports. The time of consultation was April 1985-March 2016.Age 15-87 years old. GISTs primary site: the percentage of esophagus is 1.1%, the percentage of stomach is 71.9%, the percentage of small intestine is 19.881%, the percentage of colon and rectum is 3.55.The percentage of gastrointestinal tract is 3.60.4737 cases are diagnosed as stromal tumors by pathological examination.Conclusion: early detection of gastrointestinal stromal tumors is relatively difficult, complete surgical resection is still the best treatment, for middle and high risk population, should be supplemented with molecular targeted drug treatment.
【學位授予單位】：蘭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735

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