局部晚期消化道神经内分泌肿瘤及肝转移瘤的外科治疗原则  

Surgical management of locally advanced digestive tract neuroendocrine neoplasm with or without liver metastasis

作　　者：王晓松[1] 邱江锋[1] 吴志勇[1] 

机构地区：[1]上海交通大学医学院附属仁济医院胃肠外科,200127

出　　处：《中华胃肠外科杂志》2016年第11期1222-1225,共4页Chinese Journal of Gastrointestinal Surgery

摘　　要：近年来，消化道神经内分泌肿瘤（NEN）的发生率明显增加。本研究旨在对局部晚期消化道NEN及肝转移瘤的外科治疗原则以及目前胃肠NEN分级的现状进行评述，以期能够为临床工作提供参考。2010年WHO对胃肠胰NEN重新进行分类与分级，但临床中对胃肠NEN的分类与分级仍有许多疑问，有待临床研究结果来回答。目前，手术是唯一可能治愈胃肠NEN的手段。对于局部晚期的胃肠NEN患者，应按胃肠道癌行标准或扩大根治术。对原发灶不能切除或已发生远处播散等无法行根治性手术的患者，若存在内分泌症状，可行减瘤手术；若肿瘤引起出血、梗阻等症状，姑息性手术也可使患者生存获益。肝转移灶不能切除而原发灶可切除者则应切除原发灶。如肝转移灶可切除且患者能耐受手术者，提倡行一期手术切除原发灶与肝转移灶。当肝转移灶不可切除时，可选择肝动脉化疗栓塞（TACE）、系统化疗、生物治疗、靶向治疗及（或）联合射频消融（RFA）等局部治疗，以控制肿瘤进展和症状。Neuroendocrine tumors in the digestive tractare rare, however their incidences increased obviously for the past few years. The purpose of this paper is to elucidate the surgical management of locaUy advanced digestive tract neuroendocrine neoplasms （NENs） with or without liver metastasis and to discuss the present classification of gastrointestinal NENs in order to provide reference for clinicians. WHO re-classified the gastroenteropancreatic NENs in 2010, but this classification remains many questions and needs further clinical trims to answer. Up to now, radical resection of the lesions is the only cure for the gastrointestinal NENs. For resectable locally advanced gastrointestinal NENs, standard radical or extended resection should be performed according to gastrointestinal cancer. For patients who can not receive radical procedure because of unresectable primary lesions or diffuse metastases, cytoreductive operation should be considered when endocrine symptoms exist. Palliative surgery is beneficial to the improvement of bleeding or obstruction by tumor. For unresectable liver metastatic lesion and resectable primary lesion, the primary lesion should be resected. For tolerable patients with resectable liver metastatic lesion, one-stage resection involving the primary and the liver metastatic lesions should be performed. For unresectable liver metastasis, hepatic arterial chemoembolization, systematic chemotherapy, biotherapy, targeted therapy or radio frequency ablation （RFA） should be considered to control symptoms and prevent the tumor progression.

关 键 词：神经内分泌肿瘤 局部晚期 肝转移 外科治疗 

分 类 号：R735[医药卫生—肿瘤]