胃类癌的生物学行为和诊治特点

The biologic behavior,diagnosis and treatment of gastric carcinoid tumor

目的探讨胃类癌的生物学行为和诊治特点。方法对1996年5月至2005年6月收治的11例胃类癌患者进行根治性胃切除术(包括D2+～D3淋巴结清扫术)9例,姑息性胃部分切除术2例;观察肿瘤的大体形态,并进行病理及免疫组化检查;将患者的临床表现和术后随访结果进行整理和归纳。结果肿瘤位于胃窦部4例(36.36%),胃体5例(45.45%),胃底贲门部2例(18.18%);肿瘤直径<2cm3例(27.27%),2～5cm3例(27.27%),>5cm5例(45.45%);结节型4例(36.36%),溃疡型1例(9.09%),溃疡浸润型6例(54.55%);浸润至深肌层2例(18.18%),浆膜层3例(27.27%),浆膜外6例(54.55%);区域淋巴结转移9例(81.82%);无手术并发症;4例于术后1～4年死于广泛转移及恶液质,6例健在,已生存2～7年,平均4.5年。结论胃类癌的发病与A型慢性萎缩性胃炎、高胃泌素血症、幽门螺杆菌感染等关系密切;早期诊断困难;治疗方式选择主要依据分型和病灶的大小及转移情况;手术是主要治疗方法;Ⅲ型患者淋巴结转移常见,应重视淋巴结清扫;恶性程度和预后与组织学形态、细胞分化程度、肿瘤的大小、浸润深度、转移情况有关。

Objective To investigate the characteristics of biologic behavior, diagnosis and treatment of gastric carcinoid tumor. Methods Clinicopathologic features of 11 cases of gastric carcinoid tumor were analyzed retrospectively. Upper abdominal pain was chief complaint in all patients and 2 patients went to emergency because of upper digestive tract bleeding. One patient showed carcinoid syndrome. Diagnosis of gastric carcinoid tumors was confirmed before operation in 2 cases. All patients underwent operations. Results Tumors were mainly located at sinus in 4 cases（36.4%）,corpus in 5 cases（45.5% ）, fundus and cardia in 2 cases（ 18.2% ）. The size of lesion was smaller than 2cm in 3 cases（27.3%）,2 -5cm in 3 cases（27.4%）and larger than 5cm in 5 cases（45.5%）. The most common lesion pattern was Bormann type Ⅲ （5 cases,45.5%） while 4 cases （36.4%） were type Ⅰ and 1 case （9.1%） was type Ⅱ. Pathologic examination showed lesions penetrated into deeper muscular coat in 2 cases （18.2%） and serosa in 3 cases（ 27.3% ）or over serosa in 6 cases （54.6%）. Lymph nodes metastasis were seen in 9 cases （81.8%）. Four out of 11 patients died in metastasis and dyscrasia 1 to 4 years after operation. Conclution Operation may be the first choice for patients with gastric carcinoid tumors, the prognosis is relatively satisfactory for patients undergoing surgery.