天津医药

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胃肠间质瘤的CT和内镜表现分析

何刚1,肖健宇2   

  1. 1. 天津医科大学附属肿瘤医院内镜室
    2. 天津医科大学附属肿瘤医院
  • 收稿日期:2011-02-14 修回日期:2011-08-11 出版日期:2011-12-15 发布日期:2011-12-15
  • 通讯作者: 何刚

  • Received:2011-02-14 Revised:2011-08-11 Published:2011-12-15 Online:2011-12-15

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摘要： 目的：分析胃肠间质瘤（GIST）的CT、胃镜、超声胃镜及结肠镜表现。方法：选取我院2005年1月-2009年6月4年间经镜下活检手术病理证实为GIST的患者146，其中采用GEHispeedNX/Z双层螺旋CT检查126例，采用Olympus GIF-260胃镜检查93例，行PENTEXOF-13141超声胃镜检查66例，行Olympus CF-H260AT电子肠镜检查8例，所有病人术后进行免疫组化CD117和CD34检测。结果：146例均行手术病理及免疫组织化学法检查证实为间质瘤。其中病变位于胃93例，空肠20例，十二指肠15例，回肠10例，直肠5例，横结肠3例。CT确诊率为73.01%(92/126) ，CT影像表现为胃肠外的肿块或肠壁明显增厚，肿块大小密度不均匀，良性GIST密度均匀，坏死组织少，分叶不明显；恶性分叶明显，肿块都较大，呈不均匀强化。胃镜确诊率37.6%（35/93），结肠镜确诊率37.5%(3/8)，超声胃肠确诊率100%(66/66)。超声胃镜镜下所见肿物起源于粘膜肌层23例，固有肌层43例，均为低回声团块41例；内部回声不均匀，高回声14例，伴囊性变12例。结论：内镜联合CT检查可提高术前确诊率。超声胃镜对胃肠间质瘤诊断有重要意义。

关键词: 恶性淋巴瘤, 胃肠道, 内镜诊断

Abstract: The summary to analyge the endoscopic characteristic and diagnostic point increase the positive rate of Endoscopy witht PGMIl., provide some materials for the clinical treatment . Method. The clinical materials of 67 cases with PGIML from 2000-2005 were retrospectively studied.. Result Primary gastrointestinal lymphoma has no peculiar charicters in the clinical performance.The number of performance are abdomainal pain、 malaena、 Abdominal mass.The incidence of PGIML was highest in stomach, seen in 37 of 67 patients(55.8%).Nodularity of mucosal surface was the most common endoscopic finding..The positive rate of endoscopic biopsy for the diagnosis of PGIML was 68.7%(46/67 biopsy cases)。.All cases were non-Hodgkin’s l ymphoid tissue (NHL). The most common immune phenotype was B-cell lineage that is 50cases. 30 cases were MALT. Conclusions It is hard to diagnose PGIML in early stage. The effectiveness of surgery on treating PGIML should be further confined by profound prospective randomized trials.

Key words: Malignant lymphoma, Gastrointestinal tract, Endoscopic diagnosis