小腸間質(zhì)瘤的臨床特點及誤診分析
發(fā)布時間：2019-03-04 09:20
【摘要】：背景胃腸間質(zhì)瘤(gastrointestinal stromal tumor,GIST)是一種起源于消化道的間葉源性腫瘤,組織學上富于梭形細胞、上皮樣細胞、偶爾為多形性細胞,呈條束狀、彌漫性排列;免疫表型上表達c-kit基因蛋白產(chǎn)物CD117。間質(zhì)瘤細胞多由幼稚間充質(zhì)細胞向卡哈爾間質(zhì)細胞(interstitial cell of cajal,ICC)分化形成,診斷時易與平滑肌瘤和神經(jīng)鞘膜瘤等疾病相混淆。臨床上發(fā)病率相對較低,在消化道原發(fā)性腫瘤中僅占1%,中國目前缺乏完整的發(fā)病率資料。大部分GIST原發(fā)于胃,大約占總發(fā)病人數(shù)的50-65%,小腸是GIST的第二好發(fā)部位。發(fā)生于小腸的間質(zhì)瘤統(tǒng)稱為小腸間質(zhì)瘤(small intestine stromal tumors,SIST),約占GIST的20%-35%,由于其發(fā)病率低、解剖部位隱匿、早期的臨床癥狀不典型,臨床上容易發(fā)生誤診,多誤診為婦科腫瘤、消化道平滑肌瘤等疾病。目前醫(yī)學技術的發(fā)展使得GIST的生物學行為逐漸被人們所了解、熟悉,但國內(nèi)外對SIST誤診因素方面研究相對較少,相關文獻表明國內(nèi)SIST發(fā)病率逐年升高,所以探究其臨床特點及誤診因素以減少誤診率有重要意義。目的本研究通過運用統(tǒng)計學理念及方法來回顧性分析SIST患者的臨床數(shù)據(jù)資料,探討SIST的臨床特點及引起誤診的因素,以提高對其診治水平,減少誤診的發(fā)生。方法本研究收集了104例于2010年1月至2015年1月期間在鄭州大學第一附屬醫(yī)院住院的SIST病人的完整病歷資料,所有患者均經(jīng)病理檢測確診為SIST。回顧性分析其臨床表現(xiàn)、腫瘤部位、腫瘤大小、生長方式、檢查方式等方面的臨床數(shù)據(jù)資料,把所有患者分成確診組和誤診組進行統(tǒng)計描述,應用SPSS19.0統(tǒng)計軟件進行數(shù)據(jù)分析,分析在不同因素時SIST誤診情況。計量資料用mean±SD進行描述,兩組間比較采用獨立樣本t檢驗,將對SIST發(fā)生誤診的影響因素納入二分類Logistic回歸模型進行分析,評估每個變量與是否發(fā)生誤診之間的關系。P0.05為差異具有統(tǒng)計學意義。結果SIST發(fā)病部位以空腸多見,占45.2%,其次是回腸(29.8%)、十二指腸(25%);臨床癥狀以腹部包塊67例(64.5%)、消化道出血47例(52.8%)、腹痛47例(52.8%)為主;腔外型生長是SIST最多見的生長方式;腫瘤直徑10cm占87例(83.6%),其中5cm占49例;消化內(nèi)鏡檢查在診斷時起重要作用,彩超檢查最易發(fā)生誤診;轉移部位以肝臟為主,少數(shù)出現(xiàn)腹膜、淋巴結、骨轉移等。本研究中該病誤診率高達34.6%,易誤診為婦科腫瘤(15/36)、消化道平滑肌瘤(3/36)等疾病。結論SIST是多發(fā)于空腸且以腹部包塊、消化道出血等為常見臨床表現(xiàn)的胃腸道間質(zhì)瘤,其臨床誤診率較高,其是否發(fā)生誤診受臨床表現(xiàn)、腫瘤部位、腫瘤直徑大小、生長方式、檢查方法等因素影響。對于彩超、CT、普通胃腸鏡等反復檢查不能明確診斷的持續(xù)性消化道出血、腹部包塊、長期中上腹疼痛的患者應及時行小腸鏡或膠囊內(nèi)鏡檢查。盡早行活檢及免疫組化等檢查,以便早期診斷,避免誤診。
[Abstract]:Background Gastrointestinal stromal tumor (gastrointestinal stromal tumor,GIST) is a mesenchymal tumor originating from the digestive tract. Histologically it is rich in spindle-like cells, epithelial-like cells, occasionally pleomorphic cells, in a banded, diffuse arrangement. Expression of c-kit Gene protein Product CD117. on Immunophenotype Mesenchymal tumor cells are mostly differentiated from immature mesenchymal cells to Kakhar stromal cells (interstitial cell of cajal,ICC), which may be confused with leiomyoma and neurilemmoma in diagnosis. The clinical incidence is relatively low, accounting for only 1% of primary gastrointestinal tumors, and there is no complete incidence data in China. Most of GIST is primarily located in the stomach, accounting for about 50% of the total incidence of GIST, and the small intestine is the second most common site of the disease. Stromal tumor of small intestine is called small intestinal stromal tumor (small intestine stromal tumors,SIST), which accounts for 20% of GIST. Because of its low incidence, hidden anatomic site and atypical early clinical symptoms, it is easy to be misdiagnosed in clinic. Most misdiagnosed as gynecological tumors, digestive tract leiomyoma and other diseases. At present, with the development of medical technology, the biological behavior of GIST is gradually known and familiar. However, there are relatively few studies on misdiagnosed factors of SIST at home and abroad. The related literatures indicate that the incidence of SIST in China is increasing year by year. Therefore, it is of great significance to explore its clinical characteristics and misdiagnosis factors in order to reduce the rate of misdiagnosis. Objective in order to improve the diagnosis and treatment of SIST and reduce the occurrence of misdiagnosis, the clinical data of patients with SIST were analyzed retrospectively by using statistical theory and method, and the clinical characteristics and the factors causing misdiagnosis were discussed in order to improve the level of diagnosis and treatment. Methods the complete medical records of 104 SIST patients admitted to the first affiliated Hospital of Zhengzhou University from January 2010 to January 2015 were collected. All patients were diagnosed as SIST. by pathological examination. The clinical data of clinical manifestation, tumor location, tumor size, growth pattern and examination mode were analyzed retrospectively, and all patients were divided into two groups: diagnosed group and misdiagnosed group, and all the patients were divided into diagnostic group and misdiagnosed group for statistical description. The data were analyzed by SPSS19.0 software, and the misdiagnosis of SIST in different factors was analyzed. The measurement data were described by mean 鹵SD. The independent sample t-test was used to compare the two groups. The influencing factors of misdiagnosis of SIST were analyzed by binary Logistic regression model. To evaluate the relationship between each variable and whether misdiagnosis occurred. P0.05 was statistically significant. Results the most common sites of SIST were jejunum (45.2%), ileum (29.8%) and duodenum (25%). The main clinical symptoms were abdominal mass in 67 cases (64.5%), gastrointestinal bleeding in 47 cases (52.8%), abdominal pain in 47 cases (52.8%), extraluminal growth was the most common growth mode of SIST. 10cm in diameter was found in 87 cases (83.6%), of which 49 cases were 5cm, endoscopy played an important role in diagnosis, and color Doppler ultrasonography was most likely to misdiagnose, liver was the main metastatic site, peritoneum, lymph node and bone metastasis were found in a few cases. In this study, the misdiagnosis rate was 34.6%. It was easy to be misdiagnosed as gynecological tumor (15 / 36) and gastrointestinal leiomyoma (3 / 36). Conclusion SIST is a common clinical manifestation of gastrointestinal stromal tumors in jejunum, abdominal mass, gastrointestinal bleeding, and so on. Its misdiagnosis rate is high, whether it is misdiagnosed by clinical manifestations, tumor location, tumor diameter, growth pattern, and so on. The method of examination and other factors. The patients with persistent gastrointestinal bleeding, abdominal mass and long-term upper abdominal pain who cannot be diagnosed by color Doppler ultrasonography, CT, ordinary gastroscopy and other repeated examinations should be examined by enteroscopy or capsule endoscopy in time. Biopsy and immunohistochemistry were performed as early as possible in order to diagnose early and avoid misdiagnosis.
【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.32
本文編號：2434148
[Abstract]:Background Gastrointestinal stromal tumor (gastrointestinal stromal tumor,GIST) is a mesenchymal tumor originating from the digestive tract. Histologically it is rich in spindle-like cells, epithelial-like cells, occasionally pleomorphic cells, in a banded, diffuse arrangement. Expression of c-kit Gene protein Product CD117. on Immunophenotype Mesenchymal tumor cells are mostly differentiated from immature mesenchymal cells to Kakhar stromal cells (interstitial cell of cajal,ICC), which may be confused with leiomyoma and neurilemmoma in diagnosis. The clinical incidence is relatively low, accounting for only 1% of primary gastrointestinal tumors, and there is no complete incidence data in China. Most of GIST is primarily located in the stomach, accounting for about 50% of the total incidence of GIST, and the small intestine is the second most common site of the disease. Stromal tumor of small intestine is called small intestinal stromal tumor (small intestine stromal tumors,SIST), which accounts for 20% of GIST. Because of its low incidence, hidden anatomic site and atypical early clinical symptoms, it is easy to be misdiagnosed in clinic. Most misdiagnosed as gynecological tumors, digestive tract leiomyoma and other diseases. At present, with the development of medical technology, the biological behavior of GIST is gradually known and familiar. However, there are relatively few studies on misdiagnosed factors of SIST at home and abroad. The related literatures indicate that the incidence of SIST in China is increasing year by year. Therefore, it is of great significance to explore its clinical characteristics and misdiagnosis factors in order to reduce the rate of misdiagnosis. Objective in order to improve the diagnosis and treatment of SIST and reduce the occurrence of misdiagnosis, the clinical data of patients with SIST were analyzed retrospectively by using statistical theory and method, and the clinical characteristics and the factors causing misdiagnosis were discussed in order to improve the level of diagnosis and treatment. Methods the complete medical records of 104 SIST patients admitted to the first affiliated Hospital of Zhengzhou University from January 2010 to January 2015 were collected. All patients were diagnosed as SIST. by pathological examination. The clinical data of clinical manifestation, tumor location, tumor size, growth pattern and examination mode were analyzed retrospectively, and all patients were divided into two groups: diagnosed group and misdiagnosed group, and all the patients were divided into diagnostic group and misdiagnosed group for statistical description. The data were analyzed by SPSS19.0 software, and the misdiagnosis of SIST in different factors was analyzed. The measurement data were described by mean 鹵SD. The independent sample t-test was used to compare the two groups. The influencing factors of misdiagnosis of SIST were analyzed by binary Logistic regression model. To evaluate the relationship between each variable and whether misdiagnosis occurred. P0.05 was statistically significant. Results the most common sites of SIST were jejunum (45.2%), ileum (29.8%) and duodenum (25%). The main clinical symptoms were abdominal mass in 67 cases (64.5%), gastrointestinal bleeding in 47 cases (52.8%), abdominal pain in 47 cases (52.8%), extraluminal growth was the most common growth mode of SIST. 10cm in diameter was found in 87 cases (83.6%), of which 49 cases were 5cm, endoscopy played an important role in diagnosis, and color Doppler ultrasonography was most likely to misdiagnose, liver was the main metastatic site, peritoneum, lymph node and bone metastasis were found in a few cases. In this study, the misdiagnosis rate was 34.6%. It was easy to be misdiagnosed as gynecological tumor (15 / 36) and gastrointestinal leiomyoma (3 / 36). Conclusion SIST is a common clinical manifestation of gastrointestinal stromal tumors in jejunum, abdominal mass, gastrointestinal bleeding, and so on. Its misdiagnosis rate is high, whether it is misdiagnosed by clinical manifestations, tumor location, tumor diameter, growth pattern, and so on. The method of examination and other factors. The patients with persistent gastrointestinal bleeding, abdominal mass and long-term upper abdominal pain who cannot be diagnosed by color Doppler ultrasonography, CT, ordinary gastroscopy and other repeated examinations should be examined by enteroscopy or capsule endoscopy in time. Biopsy and immunohistochemistry were performed as early as possible in order to diagnose early and avoid misdiagnosis.
【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.32
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