胃十二指肠神经内分泌瘤的诊治及预后分析

Diagnosis, treatment and prognosis of neuroendocrine tumor in stomach and duodenum

目的探讨胃十二指肠神经内分泌瘤的临床病理表现及预后情况,为其早期诊断提供依据。方法对解放军总医院2012年1月-2015年1月收治的经内镜及病理证实的20例胃十二指肠神经内分泌瘤患者的临床、内镜及病理资料进行回顾性分析。依照2010年WHO肿瘤分类标准对肿瘤进行病理分类及分级。结果 20例患者年龄55.5±10.6（35~77）岁。其中病变位于胃13例,十二指肠7例,病变最大直径为0.2~2.5cm。内径下表现为息肉样隆起、半球样黏膜下隆起及黏膜糜烂。所有病变均行内镜下治疗,包括电凝电切4例、内镜下黏膜切除术（EMR）10例、内镜下黏膜剥离术（ESD）6例,1例患者ESD治疗后追加外科手术治疗。内镜下活检及超声内镜检查有助于诊断和治疗。病理分级19例为NET 1级,1例为NET 2级。随访5~34个月无转移及复发。结论胃肠道神经内分泌瘤经早期诊断和治疗可获得满意的结果。

Objective To investigate the clinicopathological characteristics and prognosis of patients with neuroendocrine tumor in stomach and duodenum for early diagnosis. Methods The clinical, endoscopic and pathological data of 20 patients admitted to the PLA General Hospital from Jan. 2012 to Jan. 2015 and diagnosed as gastric and duodenal neuroendocrine tumor were collected for retrospective analysis. The histopathological classification of the disease was made according to the WHO 2010 Classification of the Neuroendocrine Neoplasms. Result Ten male and 10 female patients aged between 35 and 77（mean 55.5±10.6） years old were recruited in the present study. Tumor located in the stomach in 13 cases, and in duodenum in 7 cases. The maximum diameter of the tumor was 0.2-2.5cm. Endoscopic features included polypoid protrusion, hemispheric submucosal protrusion, and mucosal erosion. All the patients were treated endoscopically, among them, four patients were treated w ith electrocoagulation and electrosection, 10 by endoscopic resection（EMR）, and 6 by endoscopic submucosal dissection（ESD）. In one patient, surgical excision was done after ESD. Biopsy under gastroscopy and endoscopic ultrasonography were conducive to the diagnosis and treatment. According to the histopathological classification, 19 cases were classified as NET grade 1, and another one as NET grade 2. The follow-up study showed no metastasis and recurrence. Conclusions The early diagnosis and treatment for gastric and duodenal neuroendocrine tumor can lead to satisfactory results.