腹腔镜下根治性手术切除直肠神经内分泌肿瘤(附7例报告)

Laparocospic Radical Resection for Rectal Neuroendocrine Tumors:Report of 7 Cases

目的总结直肠神经内分泌肿瘤的临床诊断和治疗策略。方法2007年1月～2011年12月对7例直肠神经内分泌肿瘤行腹腔镜下根治性切除。游离肠管周围间隙后，肿瘤下缘2em以远断直肠，距肿瘤近侧端10cm处断结肠，端端吻合器腹腔内吻合乙状结肠及直肠断端。结果腹腔镜下切除6例，中转开腹1例。2例内镜下切除者行腹腔镜下根治术后病理标本内均未见癌灶残留；余5例中，4例病理诊断为类癌，1例病理诊断为神经内分泌肿瘤Ⅱ级。3例直肠周围淋巴结转移，其中2例伴有肝转移。7例随访12～58个月，平均25．3月，1例术后半年出现直肠腺癌肝转移，再次行腹腔镜下肝转移灶切除术；1例射频消融肝转移灶后11个月复查发现直肠神经内分泌肿瘤肝转移，再次行射频消融术；余5例无复发、转移。结论直肠神经内分泌肿瘤具有恶性潜能，对于存在高危因素的肿瘤应行根治性手术治疗或密切随诊。

Objective To explore the clinical diagnosis and treatment of rectal neuroendocrine neoplasms. Methods From January 2007 to December 2011 , laparoseopic radical resection was performed on 7 patients with rectal neuroendocrine neoplasms. After tissues surrounding the rectum were separated, the rectum was cut off at 2 cm distally, the sigmoid colon was cut off at 10cm proximally, and the anastomosis was done intra-abdominally. Results Six cases underwent laparoscopic radical resection, and 1 ease was converted to open surgery. Pathological specimens showed no residual tumor in 2 cases undergoing preoperative endoscopic resection. Four of the remaining 5 cases were diagnosed as ＂ carcinoid＂ , and the remaining 1 ease was diagnosed as neuroendoerine tumors（Grade Ⅱ ）. Perirectal lymph node metastasis was observed in 3 cases, of which 2 cases developed hepatic metastases. Seven patients were followed up for 12 -58 months, with an average of 25.3 months, during which, 1 patient who was converted to open surgery experienced adenocareinoma of hepatic metastases 6 months after operation, and underwent laparoscopic liver metastases resection; 1 case developed rectal neuroendocrine neoplasm of hepatic metastases 11 months after radiofrequency ablation and received radiofrequency ablation again; other 5 patients had no recurrence or metastasis. Conclusion Rectal neuroendocrine neoplasms are potentially malignant, therefore radical resection or intense follow-up is required for tumors with potential metastasis.