小肠神经内分泌肿瘤24例临床分析  

Small Intestinal Neuroendocrine Tumors:An Analysis of 24 Cases

作　　者：钟文娟[1] 胡丽丽[1] 尹燕军[1] 张振东[2] 邱峰[1] 张战民[1] 

机构地区：[1]南昌大学第一附属医院肿瘤科,南昌330006 [2]南昌大学第一附属医院病理科,南昌330006

出　　处：《南昌大学学报（医学版）》2013年第9期34-37,共4页Journal of Nanchang University：Medical Sciences

摘　　要：目的探讨小肠神经内分泌肿瘤(NETs)的临床特点、治疗方法及预后。方法对24例小肠神经内分泌肿瘤患者的临床资料进行回顾性分析。结果分期情况:T1期7例、T2期4例、T3期4例、T4期6例,另3例无法确定。分级情况:G1级10例,G2级7例,NEC 5例,MANEC 2例。免疫组织化学:Syn、CgA、NSE阳性表达率分别为95%、79%、75%。临床表现:上腹疼痛17例,溃疡出血2例,胆系扩张、梗阻性黄疸、瘙痒5例,恶心呕吐、贫血等3例,类癌综合征1例,无症状1例。治疗:18例十二指肠NETs患者中内镜下切除6例,全身姑息化疗1例,胰十二指肠切除11例,其中术后辅助化疗6例;6例空回肠NETs患者中手术切除3例,肝转移灶介入后再行小肠病灶手术切除1例,对症治疗2例。随访:6例十二指肠NETs内镜下切除者均无病生存,11例十二指肠NETs患者术后1例死于心脏疾病,1例死于肺部感染,2例MANEC患者和未行手术治疗的1例NEC患者存活期较短,分别为13个月、10个月、5个月;6例空回肠NETs患者有2例仍然存活,其余4例出现腹腔、肝内广泛播散,均在2年后死亡。结论小肠神经内分泌肿瘤缺乏特征性临床症状,内镜有助于该病的早期诊断。尽早手术切除肿瘤可提高患者生存率,病理分期和分级与患者的生存预后密切相关。Objective To investigate the clinical features, therapy and prognosis of small intes- tinal neuroendocrine tumors（SI-NETs）. Methods Clinical data of 24 patients with SI-NETs were retrospectively analyzed. Results Among the 24 patients,7 had T1 tumors,4 had T2 tumors,4 had T3 tumors,6 had T4 tumors,and 3 were not confirmed. In addition,SI-NETs were divided in- to four grades： G1 （10 cases） ,G2 （7 cases） ,NEC（5 cases） and MANEC （2 cases）. Immunohisto- chemical analysis showed that the positive expression rates of Syn,CgA and NSE were 95~ ,79~ and 75 %,respectively. Epigastric pain was found in 17 cases, ulcer bleeding in 2, biliary tree expansion obstructive jaundice and pruritus in 5, nausea, vomiting and anemia in 3, carcinoid syndrome in 1 ,and no symptoms in 1. Among the 18 patients with duodenal NETs,endoscopic resection was performed in 6, systemic palliative chemotherapy in 1, and pancreaticoduodenectomy in 11. Among the 11 patients undergoing pancreaticoduodenectomy, 6 received postoperative adju- vant chemotherapy. Among the 6 patients with jejuno-ileal NETs, surgical excision was performed in 3, small intestinal lesion resection after liver intervention in 1, and symptomatic treatment in 2. Follow-up results showed that 6 patient undergoing endoscopic resection survived without recur- rent disease. Among the 11 patients with duodenal NETs, 1 died of cardiac disease and 1 died of pulmonary infection. The survival time was 13,10 and 5 months in 2 MANEC patients and 1 NEC patient who did not receive surgical treatment, respectively. Among the 6 patients with jejuno-ileal NETs, 2 survived, but 4 had intrahepatic and intraabdominal spread and died after two years. Con- clusion SI-NETs lacks of specific presentation. The endoscope helps the early diagnosis of the disease. Surgical excision of tumors as soon as possible can improve the survival of patients. Path- ological staging and grading are closely related to the prognosis.

关 键 词：小肠神经内分泌肿瘤 诊断 治疗 预后 

分 类 号：R735.32[医药卫生—肿瘤]