胃肠道神经内分泌肿瘤52例诊治分析

Diagnostic analysis for 52 cases of gastrointestinal neuroendocrine tumor

目的：探讨胃肠道神经内分泌肿瘤（gastrointestinal neuroendocrine tumors,GI-NETs）的临床表现、诊治方法及预后的相关影响因素。方法：根据手术方法将2004年1月至2014年10月中南大学湘雅医院胃肠外科收治的52例GINETs患者（其中1例患者因身体情况差取消了手术）分为局部切除组（n=21）与经腹切除组（n=30）,对两组患者的临床资料、治疗方法及结果进行回顾性分析。结果：52例GI-NETs患者的临床表现均无特异性,多表现为局部侵袭或压迫症状。CT表现亦缺乏较特异的征象,直径大于1 cm的GI-NETs常表现为消化道壁的局部增厚、隆起、软组织块影,体积大者可见坏死,中度强化。52例标本免疫组织化学检测嗜铬粒蛋白A阳性率为63.5%,突触素阳性率为88.5%。除1例患者因身体情况差取消手术外,其余患者均经手术治疗,经腹切除共30例（57.7%）,内镜下或经肛局部切除共21例（40.4%）。全组患者中仅7例接受放射治疗和化学治疗。随访3-132个月,共7例死亡,其余均存活。局部切除组与经腹切除组的中位生存时间分别为39.5和43.0个月,差异无统计学意义（P〉0.05）。结论：充分认识GI-NETs的生物学特征、早期诊断并及时进行个体化治疗,可望达到创伤小、生存期长的良好效果。

Objective： To investigate the clinical features, diagnosis, treatments and prognosis for gastrointestinal neuroendocrine tumors（GI-NETs）.Methods： Clincal data of 52 patients, who were diagnosed as GI-NETs between January 2004 and October 2014, were reviewed. The patients were divided into a local excision group（n=21） and a transabdominal excision group（n=30）, and the major clinical features, treatment modalities and outcomes were analyzed.Results： The clinical features of GI-NETs were nonspecifi c, and most of the clinical manifestation were local invasiveness. CT scan was lack of specific findings. GI-NETs greater than 1 cm often showed local incrassation, upheaval and soft tissue shadow. In the case of lager GI-NETs, necrosisand moderate enhancement could be seen. Positive ratio for expression of chromogranin A（Cg A） and synaptophysin（Syn） in the 52 cases of specimen were 63.5% and 88.5%, respectively. Except 1 patient, whose surgery was canceled because of poor health, other 51 patients were treated with surgery through different approaches. Among them, 30 cases were transabdominal resection（57.7%） and 21 were local resection（40.4%）. Chemotherapy and/or radiotherapy was only applied for 7 patients. After a follow-up of 40（3–132） months, 7 patients died, the rest were alive. The median survival in the local resection group and the transabdominal resection group was 43.0 and 39.5 months, respectively（P0.05）.Conclusion： Under the condition of fully understanding the biological characteristics of GI-NETs, early diagnosis and timely personalized treatment is hopeful to reach the relative good prognosis and survival.