直肠神经内分泌肿瘤外科治疗

Diagnosis and treatment of rectal neuroendocrine neoplasms

目的 探讨直肠神经内分泌肿瘤外科治疗经验.方法 回顾性分析2008年1月至2013年6月南京军区福州总医院普通外科23例直肠神经内分泌肿瘤手术患者的临床资料.结果 本组约占同期直肠肿瘤1.5％,其中男性16例,女性7例,中位年龄52.6岁（30～68岁）,平均肿瘤最大径2.2 cm（0.8～3.2 cm）,平均距肛缘距离为6.2 cm（3～12 cm）.经肛局部扩大切除7例,经腹直肠低位前切除术10例（腹腔镜手术6例）,经腹会阴联合直肠癌根治术6例（腹腔镜手术3例）,均获R0切除.其中G1级4例,G2级14例,G3级5例.无手术并发症和围手术期死亡.术后随访3个月至5年,10例发生局部复发或远处转移,8例死亡,3年和5年总体生存率分别为80.5％和55.1％.结论 应重视直肠神经内分泌肿瘤早期诊断和治疗,最大径小于1 cm者应积极内镜下治疗,最大径超过2 cm以及内镜下切除病理证实高风险者（组织学分级差、切缘阳性、可疑肌层受累）应接受根治性手术,腹腔镜手术具有一定优势.

Objective To explore the surgical experiences in the diagnosis and treatment of rec tal neuroendocrine neoplasms.Methods Retrospective analysis was conducted for the clinical data of 23 surgical cases of rectal neuroendocrine neoplasms between January 2008 and June 2013 at our hospi tal.Results Among 23 cases,there were 7 females and 16 males with a median age range of 52.6 （30 68） years.Rectal carcinoid neoplasms accounted for 1.5％ of all rectal neoplasms in the corresponding period in the series.The median tumor size in greatest dimension was 2.2 （0.8 3.2） cm.The median distance between rectal neoplasm and anal edge was 6.2 （3 12） cm.The procedures included local ex cision by transanal supplemental excision （n-7）,laparotomy （n-7） and laparoscopic operation （n-9）.Ten patients had low anterior resection and another 6 underwent Miles＇ operation.A R0 margin was achieved in all patients.Using the WHO classification （2010）,the grades were G1 （n-4）,G2 （n-14） and G3 （n-5）.There was no postoperative occurrence of complications or mortality.Ten patients had clinical evidence of regional or distant metastases and there were 8 mortalities during a fol lowup period of from 3 months to 5 years.The 3 and 5 year overall survivals were 80.5％ and 55.1％ respectively.Conclusions More attention should be paid to the early diagnosis and treatment of rectal neuroendocrine neoplasm.The management of these lesions is determined by size of lesion,involve ment of muscularis,location and presence of metastatic disease.Small lesions （＜1 cm） may be treated locally,either endoscopically or transanally.However,larger lesions （＞ 2 cm） require a formal onco logic resection.The safety and application value of laparoscopic surgery in the treatment of rectal neu roendocrine neoplasm are obviously.