胰腺混合性腺-神经内分泌癌6例诊治分析  

Pancreatic mixed adenoneuroendocrine carcinoma:A diagnosis and treatment analysis of 6 cases

作　　者：吕洋[1] 辛宝宝[1] 李剑昂[1] 韩序[1] 靳大勇[1] 楼文晖[1] 许雪峰[1] 

机构地区：[1]复旦大学附属中山医院普外科复旦大学普外科研究所,上海200032

出　　处：《中国实用外科杂志》2016年第5期559-562,共4页Chinese Journal of Practical Surgery

基　　金：卫生公益性行业科研专项经费项目(No.201202007)

摘　　要：目的探讨胰腺混合性腺-神经内分泌癌(MANEC)病人的临床病理学特征及预后。方法回顾性分析复旦大学附属中山医院普外科2004年12月至2011年10月收治的6例胰腺混合性腺-神经内分泌癌病人的临床及随访资料。结果 6例病人中,行胰十二指肠切除术+扩大淋巴结清扫3例,其中2例术后未行放化疗,分别于术后2、61个月肿瘤复发死亡,另1例病人行胰十二指肠切除术后5个月发现肝转移,肝脏穿刺活检后行肝转移介入化疗栓塞(TACE);3例胰体尾肿瘤病人,2例行胰体尾+脾切除术,另外1例为同时性肝转移病人,穿刺活检后行TACE治疗。病理学检查:瘤体平均直径为3.7 cm,肿瘤原发灶和肝转移灶均以腺癌和神经内分泌癌混合为组织形态学表现,癌细胞周围侵袭性明显。经随访,6例病人均已死亡,平均生存期为23.3个月,均死于肿瘤复发和(或)肝转移。结论胰腺混合性腺-神经内分泌癌发病率低,恶性程度高,预后差,早期诊断和治疗是改善预后的主要手段。Objective To investigate the clinicopathological features and prognosis of pancreatic mixed adenoneuroendocrine careinoma（MANEC）. Methods The clinicopathologieal characteristics and follow-up data of 6 patients with MANEC who were admitted to Zhongshan Hospital of Fudan University from December 2004 to October 2011 were analyzed and discussed retrospectively. Results Of the 6 patients, three received pancreaticoduodenectomy, in whom 1 pancreaticoduodenectomy in combination with resection and reconstruction of portal vein and 1 patient was found liver metastasis 5 months after pancreaticoduodenectomy and received the fine needle aspiration of the liver and transarterial chemoembolization （TACE）. In 3 patients with distal pancreatic tumor, 2 patients were performed distal pancreatectomy and splenectomy and other 1 patient had synchronous liver metastasis and was performed the fine needle aspiration and TACE. Histologically, mean 3.7 cm in size, the tumor and the liver metastases had mixed adenocarcinoma and neuroendocrine carcinoma. Follow-up showed the prognosis was poor and the mean survival time was 23.3 months after the operation. All patients died of tumor recurrence and （or） liver metastasis. Conclusion The pancreatic MANEC is histologically featured as the combination of adenocarcinoma and neuroendocrine carcinoma, with the highly invasive growth and poor prognosis. Currently, it is the early diagnosis and treatment that can ameliorate the prognosis.

关 键 词：胰腺混合性腺-神经内分泌癌 胰十二指肠切除术 肝转移 

分 类 号：R6[医药卫生—外科学]