直肠类癌32例临床及病理分析

Clinical and pathological analysis of rectal carcinoid tumor:a report of 32 cases

目的探讨直肠类癌的临床病理特点及治疗。方法对32例经病理诊断的直肠类癌患者的临床资料进行回顾分析,总结其临床表现、治疗情况及随访结果。结果直肠类癌以腹痛(10/32)、大便习惯改变(15/32)、便血(5/32)为主要临床表现,部分为无症状体检时发现直肠黏膜下肿物(5/32)。29例直肠类癌位于肛门8cm以内,内镜下主要表现为半球状隆起,表面黏膜正常。其中17例行超声内镜检查,肿块多位于黏膜下层,为均匀或不均匀稍低回声,边界清晰。内镜下行EMR治疗32例,1例追加外科手术治疗。22例随访5月～5年,1例因伴肝、肺转移死亡,余21例无复发。结论直肠类癌缺乏特异性临床表现,诊断主要靠内镜及组织学检查,内镜下EMR切除是主要治疗方法。

Objective To study the clinical and pathological features and management of rectal carcinoid tumor.Methods Data of 32 patients with rectal carcinoid from 2002 to 2008 were analysed retrospectively.The clinical manifestation,diagnosis,treatment and prognosis were summarized.Results The main symptoms of patients were abdominal pain（10/32）,changes in bowel habits（12/32）or hematochezia（4/32）.The tumors in 29 patients were located within 8 cm of the anal verge.The colonscopic feature was elevated lesion with normal mucosal appearance.Endoscopic ultrasonography（EUS）was performed in 17 patients and rectal carcinoids were presented as submuscosal hypoechoic masses with homogeneous echo and distinct border.Thirty-two patients accepted endoscopic mucosal resection（EMR）,1 patient accepted supplemental local resection.During the follow-up visit of 5 months to 5 years,1 patient died of lung and liver metastases.Twenty-one patients had no recurrence during the follow-up period.Conclusion The patients with rectal carcinoid show lack of characteristic features of clinical symptoms,and diagnosis depends on endoscopic and pathologic examination.Treatment by EMR is one of the major methods.