胃肠道类癌诊治及预后的临床研究

The clinical study of the diagnosis and prognosis treatment of gastrointestinal carcinoid

目的探讨胃肠道类癌的诊断和治疗方法及影响预后的因素。方法回顾分析我院1990年1月至2005年1月收治的胃肠道类癌34例的临床资料。结果34例患者中,胃类癌8例,直肠类癌10例,阑尾类癌6例,结肠类癌7例,回肠类癌3例。术前误诊率为70.6%,其中胃类癌、阑尾类癌和回肠类癌全部误诊,直肠类癌误诊率20%,结肠类癌误诊率71.4%。肿瘤直径在2cm以内、无肌层侵犯和淋巴结转移者1、3、5年累计生存率为100%、100%和92.8%;肿瘤直径超过2cm、侵犯肌层或有淋巴结转移者累积1、3、5年累计生存率为52.9%、41.2%和35.3%。结论胃肠道类癌术前误诊率高,病理学诊断是胃肠类癌确诊的主要方法,预后主要取决于早期发现、早期确诊及早期治疗,同时肿瘤的大小、浸润度、转移性、所在消化道的部位也是预后的关键。

Objective To study the clinical characteristic, diagnose, prognosis and treatment of gastrointestinal carcinoid. Methods The clinical data of 34 carcinoid tumors patients were analysized retrospectively. Results Among 34 cases of carcinoid tumors, there were 8 stomach carcinoids,10 rectum carcinoids, 6 appendix carcinoids, 8 colon carcinoids, 2 ileum carcinoids,the preoperative misdiagnosis rate was 70.6% in these carcinoids all of the stomach, appendix and ileum carcinoids were misdiagnosed. The misdiagnosis rate of the rectum and colon carcinoids were 20%,71.4% respectively. The 1-year, 3- year, 5-year accumulate live rate of those tumors which were 〈2cm tumor diameter ,nonmuscular layer invasive and nonlymph node was 100%,100% and 92.8%. The 1-year, 3-year, 5-year accumulate live rate of those tumors which were 〉2cm tumor diameter, muscular layer invasive and lymph node was 52.9%, 41.2% and 35.3%.Conclusion The misdiagnosis rate of the gastrointestinal carcinoid is high before operation. Pathological examination is the mainway of making a definite diagnosis in carcinoid tumors patients.The prognosis is mainly decided by the discovery, diagnosis and treatment as early as possible, at same time the key point of prognosis were the size, invasive, metastasis, position in digestive tract of the tumor.