胆囊神经内分泌癌的诊断与治疗(附15例报告)  

Diagnosis and treatment of gallbladder neuroendocrine carcinoma:a report of 15 cases

作　　者：朱博 马振威 刘赋斌 邓正栋 王剑明 Zhu Bo;Ma Zhenwei;Liu Fubin;Deng Zhengdong;Wang Jianming(Department of Hepatobiliary&Pancreatic Surgery,Tianyou Hospital,Wuhan University of Science&Technology,Hubei Wuhan 430064,China;Department of Pediatric Surgery,Affiliated Tongji Hospital,Tongji Medical College,Huazhong University of Science&Technology,Hubei Wuhan 430030,China;Department of Biliary&Pancreatic Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science&Technology,Hubei Wuhan 430030,China)

机构地区：[1]武汉科技大学附属天佑医院肝胆胰外科,湖北武汉430064 [2]华中科技大学同济医学院附属同济医院小儿外科,湖北武汉430030 [3]华中科技大学同济医学院附属同济医院胆胰外科,湖北武汉430030

出　　处：《腹部外科》2023年第4期281-286,共6页Journal of Abdominal Surgery

基　　金：国家自然科学基金(81874062,82072730);全国胆囊癌临床流行病学调查研究(2021051)。

摘　　要：目的探讨胆囊神经内分泌癌(gallbladder neuroendocrine carcinoma,GB-NEC)病人的临床病理特征和诊治要点。方法对2010年1月至2021年12月华中科技大学同济医学院附属同济医院收治的15例GB-NEC病人的临床病理资料进行回顾性研究,根据手术方案将病人分为根治性手术组(9例)和非根治性手术组(6例),根据是否进行化疗将病人分为化疗组(7例)和非化疗组(8例),使用SPSS(25.0版)软件分析数据,采用Kaplan-Meier法进行生存分析。结果15例病人中男性4例,女性11例,年龄为(57.3±12.8)岁。临床表现主要为腹痛、黄疸等。糖类抗原(CA)19-9水平升高5例,癌胚抗原(CEA)升高3例。超声检查提示胆囊内高回声10例。所有病人术后病理学检查证实为GB-NEC,15例病人均顺利出院,无围手术期死亡。总体生存时间为3.0~35.0个月,中位生存期为9.0个月。根治性手术组和非根治性手术组预后差异有统计学意义(P=0.001)。化疗组和未化疗组预后差异有统计学意义(P=0.015)。结论GB-NEC是一种极为少见的恶性肿瘤,其临床表现和实验室指标均无特异性,难以在术前明确诊断,主要通过常规病理及免疫组织化学检查来确诊,治疗方法首选根治性切除,结合化疗可能延长病人生存时间。Objective To explore the clinicopathological characteristics and management strategies of gallbladder neuroendocrine carcinoma(GB-NEC)patients.Methods A retrospective review was conducted for clinicopathological data of 15 GB-NEC patients admitted into Tongji Hospital from January 2010 to December 2021.According to surgical protocol,they were assigned into two groups of radical surgery(n=9)and non-radical surgery(n=6).Chemotherapy group(n=7)and non-chemotherapy group(n=8)were assigned according to whether or not chemotherapy was performed,SPSS25.0 software was utilized for data processing and Kaplan-Meier method for survival analysis.Results There were 4 males and 11 females with an average age of(57.3±12.8)years.Major clinical manifestations included abdominal pain and jaundice.There were elevated levels of carbohydrate antigen 19-9(CA19-9,n=5)and carcinoembryonic antigen(CEA,n=3).Ultrasonography revealed high echogenicity in gallbladder(n=10).Postoperative pathological examination confirmed GB-NEC in all patients.All of them were discharged smoothly without perioperative mortality.The median overall survival time was 9.0(3.0-35.0)month.There was statistically significant prognostic difference between radical and non-radical surgery groups(P=0.001),as well as between chemotherapy and non-chemotherapy groups(P=0.015).Conclusion GB-NEC is an extremely rare malignant tumor with nonspecific clinical manifestations and laboratory parameters.As a result,preoperative diagnosis is rather difficult.A definite diagnosis is confirmed through routine pathological and immunohistochemical examinations.Radical surgery is a preferred option and concurrent chemotherapy may prolong patient survival.

关 键 词：胆囊神经内分泌癌 外科治疗 预后 

分 类 号：R657.4[医药卫生—外科学]