背景:小肠间质瘤的发病率低,临床症状不典型且缺乏简便有效的检查方法,术前确诊较为困难。目的:了解小肠间质瘤的临床表现,探讨如何提高小肠间质瘤的术前诊断率和合理的手术方式,以提高其诊治水平。方法:回顾性分析1993年4月～2004年6月仁济医院收治的35例小肠间质瘤的临床表现、诊治经过、病理学特点和预后,所有病例均经手术和病理证实。结果:脐周隐痛、消化道出血、贫血、腹部肿块和小肠梗阻是本组小肠间质瘤最常见的临床表现。小肠间质瘤多好发于十二指肠和空肠;80.0%的良性小肠间质瘤瘤体直径<5cm,93.3%的恶性小肠间质瘤瘤体直径>5cm;小肠间质瘤以肠腔外生长为主,良、恶性间质瘤在生长方式上无显著差异。空肠、回肠间质瘤的术前诊断率显著低于十二指肠间质瘤(P<0.01)。胃镜、增强螺旋CT和数字减影血管造影(DSA)对小肠间质瘤检出率较高。30例恶性间质瘤中20例(66.7%)行小肠肿瘤根治术,8例(26.7%)行小肠肿瘤减瘤荷手术,2例(6.7%)行姑息性手术。30例恶性间质瘤切除标本中9例有局部淋巴结转移,5例出现远处转移。结论:合理应用辅助检查方法可提高小肠间质瘤的术前确诊率,术中对间质瘤的良、恶性判断有困难者应行根治性切除术。 BACKGROUND: The incidence of intestinal stromal tumors is low, clinical symptoms are not typical and there is a lack of simple and effective examination methods. Preoperative diagnosis is more difficult. Objective: To understand the clinical manifestations of small intestine stromal tumors, explore how to improve the preoperative diagnostic rate and reasonable surgical methods of small intestine stromal tumors so as to improve its diagnosis and treatment. Methods: The clinical manifestations, diagnosis and treatment, pathological features and prognosis of 35 cases of small intestine stromal tumors treated at Renji Hospital from April 1993 to June 2004 were retrospectively analyzed. All cases were confirmed by surgery and pathology. RESULTS: Umbilical perineal pain, gastrointestinal bleeding, anemia, abdominal mass and small bowel obstruction were the most common clinical manifestations of this group of small intestinal stromal tumors. Intestinal stromal tumors mostly occurred in the duodenum and jejunum; 80.0% of benign small intestinal stromal tumors had a tumor diameter <5cm; 93.3% of malignant small intestine stromal tumors had a tumor diameter >5cm; small intestine stromal tumors had intestinal lumen Out-growth was dominant, and there was no significant difference in growth patterns between benign and malignant stromal tumors. The preoperative diagnostic rate of jejunum and ileal stromal tumors was significantly lower than that of duodenal stromal tumors (P<0.01). The detection rate of gastroscope, enhanced spiral CT and digital subtraction angiography (DSA) was higher in small intestine stromal tumors. Of the 30 cases of malignant stromal tumors, 20 (66.7%) had radical resection of the small intestine, 8 (26.7%) had tumor resection of the small intestine, and 2 (6.7%) had palliative surgery. Of the 30 cases with malignant stromal tumor resection, 9 cases had regional lymph node metastases and 5 cases had distant metastases. Conclusion: The reasonable use of auxiliary examination can improve the preoperative diagnosis rate of small intestine stromal tumors. Radical resection should be performed for those who have difficulties in judging the benign and malignant stromal tumors.