14例Ⅲ型胃类癌临床资料分析

Type 3 gastric carcinoid: An analysis of clinical data about 14 cases

目的 探讨Ⅲ型胃类癌的临床表现、内镜下特征、病理特点和治疗方法，以提高Ⅲ型胃类癌的早期诊断和治疗水平。方法 根据Modlin 等的分型标准，对2006 年1 月- 2013 年4 月本院确诊的Ⅲ型胃类癌14 例临床资料进行回顾性总结分析。结果 本组Ⅲ型胃类癌患者以消化系统症状和肿瘤相关症状（ 出血或转移） 为主要临床表现，内镜下表现为半球形或息肉样黏膜下肿物，孤立存在，表面常伴有充血、糜烂，触之质韧或硬，有滑动感，当病变累及肌层时不易推动。3 例行内镜下治疗，2 例内镜下治疗后再行外科手术治疗，3 例行腹腔镜下胃部分切除治疗，4 例行外科开腹胃部分切除治疗（ 其中1 例术后辅以化疗），1 例发生肝转移采取化疗姑息治疗，1 例死于类癌广泛转移。随访13 例，平均随访时间11.7（3 ~ 79） 个月。结论Ⅲ型胃类癌无特异临床表现，内镜检查及病理免疫组化是早期诊断的重要手段。早期正确判断胃类癌类型，有助于正确选择治疗方法，提高生存率。

Objective To improve the early diagnosis and treatment of type 3 carcinoid by studying its clinical manifestations, endoscopic features, pathologic characteristics, and treatment modalities. Methods The clinical data about 14 patients with type 3 gastric carcinoid admitted to our hospital from January 2006 to April 2013 were retrospectively analyzed. Results The main clinical manifestations of the patients were gastrointestinal symptoms and tumor-related symptoms （bleeding or metastasis）. Endoscopy showed solitary hemispherical or polypoid submucosal tumors with congestive or erosive surfaces, which were tough or hard and could be pushed. It was hard to move when the muscular layer was involved. Of the 14 patients, 3 underwent endoscopic resection, 2 received surgery after endoscopic resection, 3 underwent laparoscopic local resection, 4 received partial gastric excision （1 received chemotherapy after operation）, and 1 received chemotherapy due to liver metastasis, 1 died of widespread metastasis of carcinoid. Thirteen patients were followed up for an average period of 11.7 months （3-79 months）. Conclusion Since type 3 gastric carcinoid lacks of specific clinical manifestations, endoscopy and immunohistochemistry are the key methods for its early diagnosis which is essential to recognize the type of gastric carcinoid, to decide its treatment modalities, and improve the survival rate of its patients.