摘要
目的探讨小肠间质瘤合并肝转移的临床特点、诊断方式、治疗原则及患者预后情况。方法利用收治的1例小肠间质瘤合并肝转移患者的临床病历资料,展开回顾性分析并复习相关文献进行总结论述。结果该例患者因体检发现小肠肿块伴肝占位入院,胸腹部增强CT示左下腹小肠区见不规则软组织肿块,肝脏左叶占位两枚。入院后行小肠镜检查发现空肠距幽门50 cm见一巨大新生物,呈菜花样,表面高低不平,活检质脆,易出血。完善检查准备后行腹腔镜下小肠部分切除+腹腔镜下肝部分切除+腹腔镜下胆囊切除术,术后常规病理示:(小肠)间质瘤,(左半肝)间质瘤转移。结论小肠间质瘤是一种相对少见的小肠肿瘤,诊断困难,临床转归多种多样;小肠间质瘤最常见的转移部位是肝脏,明确诊断依赖病理,对于疑似病人应常规影像学检查,必要时完善内镜及病理活检,一旦确诊应在合理应用靶向药物TKI并保障残肝满足生命需求的前提下积极手术,力争R0切除并根据术后病理决定进一步治疗方案。
Objective To explore the clinical features,diagnosis,treatment options and prognosis of liver metastasis from small bowel gastrointestinal stromal tumor.Methods A retrospective analysis was conducted on the clinical medical records of 1 patient with liver metastasis from small bowel gastrointestinal stromal tumor patient admitted to department of general surgery.We search and review relevant literatures for a summary and conclusion about it.Results This patient was admitted to the hospital for a week after physical examination revealing a small intestinal mass with hepatic space.The enhanced CT of the chest and abdomen showed irregular soft tissue masses in the small bowel area of the left lower abdomen and two space-occupying lesions in the left hemiliver.After admission,the endoscopy revealed a huge lately formed mass attached to jejunum which was 50 cm from the pylorus,cauliflower-like,fragile and easily bleeding with uneven surface.After completion of other examinations and excluding surgical contraindications,laparoscopic partial small bowel resection+laparoscopic partial hepatectomy+laparoscopic cholecystectomy was performed.Postoperative routine pathology shows:(small bowel)gastrointestinal stromal tumor(GIST)and(left hemiliver)GIST metastasis.Conclusion GIST is a rare tumor of the small bowel,which can be difficult to diagnose and has a varied clinical outcome.Distant metastasis of GIST arises predominantly in the liver.Pathological diagnosis is the gold standard of GIST.For suspected patients,routine imaging examinations should be performed,and endoscopy and biopsy should be perfected if necessary.Once confirmed,the targeted drug TKI should be used reasonably and active surgery should be performed on the premise of ensuring that the residual liver meets the needs of life.R0 resection is demanded to avoid recurrence and further treatment plan will be determined according to the postoperative pathology.
作者
陈国梁
侍新宇
姚慧慧
武冠廷
顾闻
万岱维
汪良
何宋兵
CHEN Guo-liang;SHI Xin-yu;YAO Hui-hui;WU Guan-ting;GU Wen;WAN Dai-wei;WANG Liang;HE Song-bing(Department of Medicine,Soochow University,Suzhou,Jiangsu,215123,China;Department of General Surgery,the First Affiliated Hospital of Soochow University,Suzhou,Jiangsu,215006,China)
出处
《中国血液流变学杂志》
CAS
2021年第1期81-87,共7页
Chinese Journal of Hemorheology
基金
江苏省自然科学基金项目(BK20191172)
江苏省“科教强卫工程”青年医学人才项目(QNRC2016735)
江苏省研究生科研创新项目(KYCX19_1993)
苏州市姑苏卫生重点人才计划(GSWS2020005)。
关键词
胃肠道间质瘤
肝转移
小肠
临床特点
诊断
治疗
GIST
liver metastasis
small bowel
clinical features
diagnosis
treatment
