79例经内镜检出的胃肠道类癌的回顾性分析及文献复习

Retrospective analysis of 79 gastrointestinal carcinoids diagnosed by endoscopy and review of literature

目的探讨胃肠道类癌的临床表现,内镜、病理特点及治疗选择,以提高胃肠道类癌的诊疗水平。方法解放军总医院2007年1月-2011年3月经内镜检出并经病理证实的类癌患者79例,对其临床表现、内镜下表现、病理诊断、治疗方法、有无转移及治疗效果等资料进行回顾性分析,并结合文献进行复习。结果本组79例胃肠道类癌患者中,胃类癌占12.7%(10/79),十二指肠类癌占11.4%(9/79),乙状结肠类癌占1.3%(1/79),直肠类癌占74.6%(59/79),均无典型临床表现。内镜下表现为息肉样或黏膜下隆起性肿物。本组31例经活组织检查确诊,48例经术后病理确诊。41例行免疫组化,结果显示嗜铬粒蛋白A(CgA)、突触素(Syn)、CD56阳性率较高,分别为34.1%、100.0%和80.5%。本组患者62例行内镜下治疗且治愈。本组患者类癌转移率较低,为7.6%(6/79)。结论类癌早期缺乏典型的临床表现,胃肠镜检查及病理是发现、诊断类癌的重要手段。治疗方式的选择可依据肿瘤大小、浸润深度、有无淋巴结转移及远处转移而定。符合内镜下治疗标准的病例,应首选内镜下治疗。

Objective To explore clinical manifestations,endoscopic and pathologic characteristics,and treatment of gastrointestinal carcinoids,thus improving diagnosis and treatment.Methods The clinical data of a total of 79 cases of gastrointestinal carcinoids discovered via endoscopy and diagnosed pathologically in General Hospital of People＇s Liberation Army from January 2007 to March 2011 were retrospectively analyzed,including clinical features,appearance in endoscopy,pathological diagnosis,treatment,occurrence of metastasis of the carcinoid,and treatment effects.Furthermore,a review of literature was conducted.Results Among the 79 patients with gastrointestinal carcinoids,those with stomach carcinoids accounted for 12.7%（10/79）,duodenal carcinoids 11.4%（9/79）,carcinoids of the sigmoid colon 1.3%（1/79）,and rectal carcinoid 74.6%（59/79）.There were no typical clinical manifestations in all of the 79 patients.Endoscopic findings were primarily polypoid or submucosal tumor.Up to 31 cases were diagnosed through pathological examination of biopsy specimens,whereas 48 cases were diagnosed after operative treatment.Immunohistochemistry was conducted in 41 specimens,and the results indicated that the positive rate of chromaffin granule A（CgA）,synaptophysin（Syn）,and CD56i was 34.1%,100%,and 80.5%,respectively.A total of 62 patients were cured successfully under endoscopy.Furthermore,the metastasis rate was low（7.6%,6/79）.Conclusions There was no specific clinical manifestation in the early stage of the carcinoids,and gastrointestinal endoscopy and pathology were the main tools for their discovery and diagnosis.The treatment method for gastrointestinal carcinoid was dependent on the size of tumor,infiltration,and metastasis.Endoscopic treatment should be the first choice for patients who meet the criteria of endoscopic excision.