Accurate embolization of gastrointestinal stromal tumor with acute gastrointestinal hemorrhage via radial artery: A case report
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摘要: 介绍1例供血血管极为丰富的左上腹胃肠间质瘤(gastrointestinal stromal tumor，GIST)致急性消化道大出血患者的联合诊治过程。该患者初期起病隐匿，肿瘤供血血管非常丰富，诊断困难，经过多次探查出血血管失败，多学科紧急会诊后至放射介入科。放射介入科行急诊腹腔动脉造影并肿瘤血管介入栓塞术迅速止血，患者一般情况明显好转后转入胃肠外科行肿瘤切除术治疗好转后出院。此次诊治过程体现了介入血管造影术和栓塞止血术在供血血管隐匿丰富的GIST患者中的重要价值，尤其是合并急性消化道出血并发症的GIST患者。介入血管造影术和栓塞止血术可及时明确供血血管、超选择精准栓塞止血，为外科手术创造条件，改变患者最终预后结局。Abstract: This article describes the combined diagnosis and treatment of a case of acute gastrointestinal massive hemorrhage caused by left upper abdominal gastrointestinal stromal tumor(GIST) with abundant blood vessels. The initial onset of the patient was insidious, and the blood vessels supplied by the tumor were very rich, making it difficult to diagnose. After repeated failures in the detection of bleeding vessels, the patient finally came to the Department of Interventional Radiology after multidisciplinary emergency consultation. The Department of Interventional Radiology performed emergency celiac arteriography and interventional embolization of tumor vessels to quickly stop the bleeding, which saved the patient's life at the critical moment. After the patient's general condition improved significantly, she was transferred to gastrointestinal surgery for tumor resection and was discharged after improvement. This diagnosis and treatment process reflects the important value of interventional angiography and embolization hemostasis in GIST patients with hidden abundant blood supply vessels, especially GIST patients with acute gastrointestinal bleeding complications. Interventional angiography and embolization hemostasis can timely identify blood supply vessels, superselective and precise embolization to stop bleeding, create conditions for surgery, and change the final prognosis of patients.
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[1] Uzunoglu H, Tosun Y, Akinci O, et al. Gastrointestinal stromal tumors of the stomach: a 10-year experience of a single-center[J]. Niger J Clin Pract, 2021, 24(12): 1785-1792. doi: 10.4103/njcp.njcp_558_20
[2] Li J, Shen L. The current status of and prospects in research regarding gastrointestinal stromal tumors in China[J]. Cancer, 2020, 126(Suppl 9): 2048-2053.
[3] Mazer L, Worth P, Visser B. Minimally invasive options for gastrointestinal stromal tumors of the stomach[J]. Surg Endosc, 2021, 35(3): 1324-1330. doi: 10.1007/s00464-020-07510-x
[4] Azimi B, Shahrbaf MA, Iranshahi M, et al. A case of jejunal GIST revealed by hematemesis: unusual situation[J]. Int J Surg Case Rep, 2022, 94: 107146. doi: 10.1016/j.ijscr.2022.107146
[5] Tada Y, Yamamoto M, Sawata S, et al. Ruptured small intestinal stromal tumor causing concurrent gastrointestinal and intra-abdominal hemorrhage: a case report[J]. Yonago Acta Med, 2021, 64(1): 137-142. doi: 10.33160/yam.2021.02.019
[6] 余永豪. 胃肠道间质瘤临床特征及预后影响因素分析[J]. 现代肿瘤医学, 2021, 29(18): 3251-3254. doi: 10.3969/j.issn.1672-4992.2021.18.024
[7] Caturegli I, Raut CP. Gastrointestinal stromal tumors and the general surgeon[J]. Surg Clin North Am, 2022, 102(4): 625-636. doi: 10.1016/j.suc.2022.04.005
[8] 柴宁莉, 汤小伟, 李惠凯, 等. 中国胃肠间质瘤内镜下诊治专家共识意见(2020, 北京)[J]. 中华胃肠内镜电子杂志, 2020, 7(4): 176-185. doi: 10.3877/cma.j.issn.2095-7157.2020.04.002
[9] 林晨, 张再重, 王烈. 胃肠间质瘤诊断和治疗进展[J]. 肿瘤防治研究, 2022, 49(1): 1-4. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLFY202201014.htm
[10] Pih GY, Jeon SJ, Ahn JY, et al. Clinical outcomes of upper gastrointestinal bleeding in patients with gastric gastrointestinal stromal tumor[J]. Surg Endosc, 2020, 34(2): 696-706. doi: 10.1007/s00464-019-06816-9
[11] 聂皓, 张国梁. 《胃肠间质瘤精准诊疗与全程化管理》出版: 腹腔镜下胃肠间质瘤切除术治疗胃不利部位胃肠间质瘤的效果及对免疫功能的影响[J]. 介入放射学杂志, 2022, 31(9): 949. https://www.cnki.com.cn/Article/CJFDTOTAL-JRFS202209032.htm
[12] Hitscherich KJ, Garg M, Petrelli NJ, et al. Characteristics of Gastrointestinal Stromal Tumors incidentally discovered during abdominal surgery[J]. Am J Surg, 2021, 222(5): 983-988. doi: 10.1016/j.amjsurg.2021.04.010
[13] 张李, 王昕宇, 王鹏亮, 等. 腹腔镜对比开腹手术治疗胃部胃肠间质瘤的疗效研究[J]. 肿瘤学杂志, 2021, 27(6): 450-454. https://www.cnki.com.cn/Article/CJFDTOTAL-XHON202106007.htm
[14] 张鹏, 陶凯雄, 王国斌. 开展胃肠间质瘤相关临床研究的启示[J]. 中国实用外科杂志, 2022, 42(4): 394-397. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWK202204006.htm
[15] Fabbi M, Castoldi L, Sallusti M, et al. Duodenal gastrointestinal stromal tumor: a rare disease in a young adult female patient presenting with life-threatening hemorrhage[J]. Case Rep Gastroenterol, 2021, 15(2): 519-524. doi: 10.1159/000515370
[16] Aguayo WG, Moyon FX, Molina GA, et al. A bleeding GIST in pandemic times, a cooperative approach to a delayed complication, a case report[J]. Int J Surg Case Rep, 2020, 77: 880-884. doi: 10.1016/j.ijscr.2020.11.138
[17] 张瑞军, 戴晶, 杨桥, 等. 急性上消化道出血救治快速通道效果评价分析[J]. 临床急诊杂志, 2022, 23(12): 827-831.
[18] 杨晓亚, 崔朝勃, 王金荣. 桡动脉穿刺前手部血液供应的评估方法[J]. 临床急诊杂志, 2020, 21(6): 512-516. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZLC202006021.htm
[19] 石敬勇, 李彬, 周杨, 等. 胃肠间质瘤中Ki-67表达对患者预后的作用[J]. 中华实用诊断与治疗杂志, 2021, 35(6): 569-571. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZD202106006.htm
[20] 徐君毅, 张雪梅, 宋学民, 等. miR-17-5p在胃肠道间质瘤组织中的表达及其对GIST882细胞增殖与凋亡的影响[J]. 中国肿瘤生物治疗杂志, 2021, 28(7): 721-727. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLSW202107011.htm
[21] Ye LJ, Li K, Xu KM, et al. Multiple metastatic extra-gastrointestinal stromal tumors with plasmoid differentiation: a case report and review of literature[J]. Intern Med, 2023, 62(3): 393-398.
[22] Giordano A, Moroni F, di Filippo G, et al. Emergency duodenal resection for giant GIST with acute gastrointestinal bleeding A case report[J]. Ann Ital Chir, 2021, 10: S2239253X21036707.
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