十二指肠神经内分泌肿瘤7例临床分析

Duodenal Neuroendocrine Neoplasm:A Clinical Analysis of 7 Cases

目的 探讨十二指肠神经内分泌肿瘤（neuroendocrine neoplasm,NEN）的临床病理学特征与外科治疗效果.方法 回顾性分析2011年1月至2014年10月在昆明医科大学第二附属医院治疗的7例十二指肠NEN的临床病理学特征与外科治疗效果并复习文献.结果7例十二指肠NEN中,男性4例,女性3例;发病年龄29～62岁,平均46.8岁;临床表现为腹部及腰背部疼痛3例,皮肤巩膜黄染3例,黑便1例;7例患者行胃镜检查发现十二指肠肿物,肿瘤位于十二指肠降段3例,乳头2例,球部1例,水平段1例;免疫组织化学染色结果：嗜铬粒素A（Cg A）阳性率为42.8%（3/7）,突触素（Syn）阳性率为71.4%（5/7）,1例Ki-67阳性指数≤2%（G1期）,其余6例Ki-67阳性指数为3～20%（G2期）;7例患者均行胰十二指肠切除术（其中1例姑息性切除）,术后随访7～46个月,目前所有病例均长期存活.结论 十二指肠NEN应积极手术治疗以改善患者预后.

Objective To study the clinicopathological features of duodenal neuroendocrine neoplasm （NEN） and its surgical treatment outcome. Methods Clinical data about 7 duodenal NEN patients and its surgical treatment outcome were retrospectively analyzed with its related literature reviewed. Results Of the 7 patients, 4 were males and 3 were females. They developed duodenal NEN at the age of 29-62 years （mean 46.8 years） . Duodenal NEN was manifested as abdominal pain in 3 cases, as jaundice in 3 cases and as melena in 1 case. The tumor was found on endoscopy in all of 7 cases, and the tumor was located at descendant duodenum in 3 cases, at duodenal papilla in 2 cases, at duodenal bulb in 1 case and at horizontal duodenum in 1 ease. The positive rates of CgA and Syn were 42.8% （3/7） and 71.4% （5/7） by immunohistochemical staining, respectively. Ki-67＋ ≤ 2% was observed in 1 case （G1） while Ki-67＋ 3-20% was observed in 6 cases （G2） . 6 cases underwent radical pancreaticoduodenectomy and 1 ease underwent palliative resection. All patients were followed up for 7～46 months after operation. All of 7 patients are still alive by now. Conclusion Actively surgical resection can improve the prognosis of duodenal NEN patients.