消化道恶性类癌合并肝转移的诊治

The diagnosis and treatment of liver metastasis from alimentary carcinoid

目的：探讨消化道恶性类癌肝转移的有关诊断和治疗问题及原发灶和继发灶的处理。方法：９例病人肝转移灶均为多发结节性，其中囊性病灶４例。合并类癌综合征８例。手术切除原发病灶６例（６６７％），肝转移灶切除１例，无手术死亡。应用生长抑素３例。术后局部灌注化疗４例，全身化疗６例。结果：应用生长抑素３例全部控制症状。７例随访５～１４年，５年生存率为２８６％（２／７）。局部灌注化疗４例生存期明显延长。结论：肝转移灶误诊率较高，尤为囊性时。对原发灶，只要全身情况允许，无论转移灶能否去除，均应争取切除。对术后局部复发者仍应力争切除复发肿瘤。对伴有类癌综合征者应给予生长抑素治疗，并选用甲氮咪胺（ＤＴＩＣ）为主的化疗方案治疗，化疗间歇期加用免疫治疗。

Objective:To discusse the diagnosis,the characters of liver metastatic tumor and the treatments of primary and metastasic tumor in 9 patients with progressive liver matsatases secondary to alimentary carcinois.Method:The liver matastasic tumors were nodose and multiple in all cases. The capsular tumor was known in 4 cases.There were 8 cases of carcinoid syndrome in 9 petients. The primary tumors were resected in 6 of the 7 patients. None of patients had died in operation.There were 4 cases using local infusion chemotherapy,6 cases using whole body chemotherapy and 3 cases using sandostatin and somatostatin after operation.Results:The 7 cases were followed up for 5～14 year .The mean 5year survival rate was 28.6%(2/7).Conclusion:The misdiagnosis of the metastasis tumor in liver was common,espacialy in capsular metastasis tumore.The resection of primary tumor should be strived for these patients of liver metastasis as long as the physical condition permits.The local recurrence tumor should also be ,if possible,strived for resection.The sandostatin and somatostatin should be first applied to patients of the carcinoid symdron,samely,the progressive liver metastasis tumors should be treated.The therapeutics of the first elected was chemoembolization or injection chemotherapy of capsular lumen.The chemotherapy protocol with decarbazine and the immunotherapy in intermittent of chemotherapy were reliable.