十二指肠神经内分泌癌9例临床分析

Duodenal neuroendocrine carcinoma： a clinical analysis of 9 patients

目的探讨十二指肠神经内分泌癌（DNEC）的临床表现、内镜下特点、病理特征、治疗方式及预后，提高其诊疗水平。方法回顾性分析青岛大学附属医院2006年12月至2014年12月确诊的DNEC9例临床资料。结果9例患者中，男性6例，女性3例，发病年龄48～75岁不等，平均61．5岁，男女比例2：1。主要临床表现包括上腹痛7例，皮肤巩膜黄染4例，黑便1例，1例无症状。病变好发于十二指肠降段，多为单发。5例行胰十二指肠切除术，2例行局部手术切除，1例行胃大部切除术，1例行逆行胰胆管造影胆管支架置入术（ERCP）缓解症状。术后随访3～40个月。5例行根治性切除患者，4例健在，1例发生肝转移而死亡；4例行姑息性治疗患者，1例健在，2例死亡，1例失访。结论DNEC临床表现无特异性，内镜及病理免疫组化检查是早期诊断的重要手段，应积极手术治疗，改善患者预后。

Objective To＇sturdy the clinical manifestations, endoscopic features, pathological fea- tures, treatment and prognosis of patients with duodenal neuroendocrine carcinoma （DNEC）. Methods The clinical data of 9 patients with duodenal neuroendocrine carcinoma who were admitted to our hospital from December 2006 to December 2014 were retrospectively analyzed. Results There were 6 males and 3 females. The mean age was 61.5 years （range 48 -75 years）. The clinical manifestations were abdominal pain （ n = 7 ） , jaundice （ n = 4 ） , melena （ n = 1 ） and asymptomatic （ n = 1 ）. The DNEC was usually solita- ry in the duodenum. The operations included duodenopancreatectomy （ n = 5 ）, surgical resection （ n = 2）, subtotal gastrectomy （ n = 1 ）, and 1 patient was palliated by common bile duct stenting using an endoscopic retrograde cholangio-pancreatographic （ERCP） approach. The patients were followed up for 3 -40 months after operation. For the 5 patients who underwent radical excision d were alive. One patient died from liver metastasis. For the 4 patients who underwent palliative therapy, one was alive, two died and one lost to follow-up. Conclusions The clinical manifestations of duodenal neuroendocrine carcinoma were non-speci- fic. Endoscopic, pathologic and immumohisotochemical tests were important in the diagnosis. Surgical resec- tion improved the prognosis of these patients.