38例消化系统神经内分泌癌的临床诊疗分析

Clinicopathologic features, diagnosis and treatment of 38 neuroendocrine carcinoma in the digestive system

目的 探讨消化系统神经内分泌癌的临床病理特点及其诊疗.方法 回顾性分析1985年1月至2008年3月间收治的38例消化系神经内分泌癌的临床资料.结果 本组男29例,女9例.有黑便或便血21例（55%）.腹痛19例（50%）,腹部包块15例（39%）,便秘14例（37%）,直肠肿物12例（32%）,腹胀11例（29%）,大便次数增多或腹泻7例（18%）.均采用手术治疗,其中1例行食管癌根治术,5例行根治性全胃切除.1例行姑息性近端胃切除术,2例行胃局部切除术,6例行胰十二指肠切除术,1例行胰体尾切除,3例行小肠部分切除术,7例行根治性右半结肠切除术,5例行经腹 直肠癌前切除术,3例行腹会阴联合直肠癌根治术,4例行直肠局部切除术.36例患者获得3～144个月的随访,中位随访时间70个月,1、3、5年生存率分别为94.7%、86.8%和57.9%,中位生存期为62个月.肿瘤浸润深度超过肌层组的生存期[（36±5）个月]明显短于肿瘤浸润深度未超过肌层组[（73±5）个月]（P〈0.05）.有淋巴结转移组的生存期[（34±7）个月]明显短于无淋巴结转移组[（74±5）个月]（P〈0.05）.结论 消化系统神经内分泌癌的临床表现无特异性,手术治疗是有效的方法.

Objective To investigate the clinicopathologic features, diagnosis and treatment of neuroendocrine carcinoma（NEC）in the digestive system. Methods Thirty-eight patients with NEC from Jan 1985 to Mar 2008 were analyzed retrospectively and the related literatures were reviewed. Results There were 29 males and 9 females. Common symptoms were melena or hematochezia（n=21,55%）,abdominal pain（n=19,50%）,abdominal mass（n=15,39%）,constipation（n=14,37%）,rectal maas（n=12,32%）,abdominal distention（n=11,29%）and diarrhea（n=7,18%）.All the patients received surgical treatment including 1 esophagectomy,5 radical total gastrectomies,1 palliation proximal gastric resection,2 local gastric resections,6 pancreaticoduodenectomies,1 distal pancreatectomies,3 partial small intestine resections,7 radical right hemicolectomies,5 Dixon operations,3 Miles operations,and 4 local resections of rectal tumor. Thirty-six patients received follow-up.The follow-up time ranged from 3 months to 144 months（median,70months）.The 1-,3-and 5-year survival rates were 94.7%,86.8%.and 57.9%respectively.The median survival time was 62 months.The survival time of the patients with carcinoma infiltration exceeding bowel muscularis propria was（36±5）months,significantly shorter than that of patients without carcinoma infiltration exceeding the bowel muscularis propfia[（73±5）monks,P〈0.05].The survival time of the patients with positive lymph node metastasis was（34±7）months,significantly shorter than that of patients with negative lymph node metastasis[（74±5）months,P〈0.05].Conclusions Clinical symptoms,signs of neuroendocrine carcinoma in the digestive system are nonspecific.The correct diagnosis should depend on histopathologic examination. Systematic treatments including radical resection of NEC are the preferable treatment.