目的 探討小腸間質瘤的臨床表現、病理免疫組織化學特征與治療方法。 方法 回顧性分析2007年1月－2011年7月70例小腸間質瘤患者的臨床表現，免疫組織化學特征及治療手段。 結果 小腸間質瘤患者并無特異性臨床表現，主要臨床表現包括腹痛、腹脹、血便，腹部包塊等。極低風險5例，低風險18例，中風險13例，高風險34例。免疫組織化學顯示CD117、DOG1、CD34、S-100、平滑肌肌動蛋白（SMA）、增殖細胞核抗原（Ki-67）、人結蛋白（Desmin）的陽性率分別為95.7%（67/70）、100%（11/11）、51.4%（36/70）、5.7%（4/70）、12.9%（9/70）、60.0% （42/70）、0% （0/70）。治療上主要以手術完整切除為主，伊馬替尼主要用于無法切除，轉移或中、高危險度的患者。 結論 小腸間質瘤患者臨床表現缺乏特異性表現，發現時往往腫瘤較大、風險度高，選擇合理的輔助檢查方法可以提高其檢出率，目前手術是首選的治療方式。
Objective To investigate the clinical characteristics， diagnosis， and treatment of gastric stromal tumor. Methods Clinical data of 217 patients with gastric stromal tumor from October 2007 to July 2011 were analyzed. Results The main clinical manifestation were abdominal pain， abdominal distension， bloody stools， abdominal mass， and so on. The tumour located at cardiac part， fundus of stomach， body of stomach， and pylorus part was 24 cases （11.0%）， 103 cases （47.5%）， 59 cases （27.2%）， and 31 cases （14.3%）， respectively. All the 217 patients underwent endoscopic or surgical resection and diagnosed by pathology and immunohistochemistry. The patients of high-low risk， low risk， intermediate risk， and high risk was 56 cases （25.8%）， 67 cases （30.9%）， 41 cases （18.9%）， and 53 cases （24.4%）， respectively. One hundred and forty patients were followed-up for 7-52 months （average 35 months）. Thirty-five patients of high risk were investigated about the drug treatment after the first operation：19 cases were treated by using imatinib （tumor progressed in 2 cases） and 16 patients were not （tumor progressed in 9 patients）. The rate of progression of patients treated by imatinib was significantly lower than another group （χ2=8.426， P=0.004）. In 11 patients with tumor progressed， tumor recurrnce in 4 cases， tumor recurrence with diffused abdominal cavity metastasis in 1 case， tumor metastasized to humerus in 1 case， metastasized to liver and abdominal cavity in 1 case， and metastasized to liver in 4 cases. Conclusions Gastric stormal tumor is lack of specific clinical manifestations. Complete excision of the tumor is the main therapy method， and imatinib can improve prognosis.
目的 探討胃腸道外間質瘤（EGIST）的臨床表現、外科治療及預后。 方法 回顧性分析2004年1月－2010年6月收治的35例EGIST患者的臨床資料。男26例，女9例；年齡33～78歲，平均56歲。病程5 d～8個月，平均2個月。臨床表現主要有腹部不適、腹痛及腹部包塊等。均在術前行CT或腹部增強CT等檢查發現病灶，其中位于系膜16例，網膜15例，腹膜后4例。35例均行手術治療。 結果 術后均由病理學檢查及免疫組織化學檢測確診，腫瘤標本鏡下均以梭形細胞為主；極低危險、低危險、中危險、高危險患者分別為0、3、0、32例。免疫組織化學檢測示酪氨酸激酶受體（CD117）、DOG-1、骨髓干細胞抗原（CD34）、酸性鈣結合蛋白、平滑肌肌動蛋白、結蛋白陽性率分別為91.4%（32/35）、100%（3/3）、71.4%（25/35）、8.6%（3/35）、22.9%（8/35）、0%（0/35）。15例患者均獲隨訪，時間19～96個月，平均46個月。8例出現進展，7例病情穩定。 結論 EGIST發現時往往體積較大，預后較差，手術切除是首選治療手段，甲磺酸伊馬替尼對其具有較好的治療效果。
ObjectiveTo evaluate the lymphatic tracing effects of nano-carbon particles for radical gastrectomy. MethodsTotally eighty-six cases of gastric cancer patients were randomly divided into experimental group (n=43) and control group (n=43). In the experimental group, nanocarbon was injected into the subserosa around the tumor for lymphatic tracing before operation, while no tracer was given in the control group. Then the number of lymph nodes dissected, operation time, and postoperative complications of patients were compared. ResultsThe number of lymph nodes dissected in patients of experimental group was 30.20±11.63 (17-45), which was significantly more than that of control group 〔22.47±7.60 (15-31)〕, Plt;0.05. The blacken rate of lymph nodes in patients of the experimental group was 74.56% (1 260/1 690). Of 302 metastatic lymph nodes, the blacken rate of metastatic lymph nodes was 61.26% (185/302), which was significantly higher than the nonblacken rate of metastatic lymph nodes (38.74%, 117/302), Plt;0.05. The operation time of patients in experimental group 〔(3.51±0.43) h〕 was not different from that in control group 〔(3.49±0.51) h〕, Pgt;0.05. The postoperative complications of patients in two groups was not different and no local or systemic adverse reaction occurred in patients of experimental group. ConclusionSubserosal injection of nanocarbon particles around the tumor is safe and can provide the guidance to lymph node dissection in radical gastrectomy.