直肠神经内分泌肿瘤临床病理表现和诊疗分析

Clinicopathologic characteristics and therapy of rectal neuroendocrine tumors

目的探讨直肠神经内分泌肿瘤(rectal neuroendocrine tumor,RNET)的临床病理特征和治疗方法。方法收集58例RENT患者的临床资料,对其临床表现、病理分期和分级、治疗方法、术后随访资料进行分析。结果 58例RENT患者,男性34例,女性24例,平均年龄(50.2±11.3)岁。大便习惯改变28例(48.3%),便血20例(34.5%)。肿瘤位于直肠下端29例(50.0%),位于直肠中端18例(31.0%),位于直肠上端12例。肿瘤直径<1 cm 27例(46.6%),直径1~2 cm 16例(27.6%),直径>2 cm 15例。病理类型RNET(G1)23例(39.7%)、RNET(G2)16例(27.6%)、RNEC(G3)15例、RMANEC(G3)4例。免疫组织化学指标突触素(Syn)阳性率100%,嗜铬颗粒蛋白(CgA)阳性者60.4%。内镜下切除18例(31.0%),经肛门局部切除21例(36.2%),Dixon手术14例(同时行肝脏减瘤手术3例),Miles手术5例(2例行肝脏介入治疗)。术后12例接受化疗。术后52例患者获访,6例失防,随访时间为5~48个月,中位随访时间为29个月。随访期间有2例腹股沟淋巴结转移,5例复发,3死亡病例。结论 RNET临床表现以大便习惯改变和便血为主,多位于直肠中下端,直径多<2 cm。病理分型以RNET(G1,G2)多见。对于直径1~2 cm无肌层或淋巴结浸润的RNET(G1和G2)内镜或经肛局部切除可获得满意疗效,对于直径>2 cm有肌层或淋巴结浸润的RNEC(G3)和RMANEC(G3)须行根治性手术切除。

Objective To analyze clinicopathologic characteristics and therapy of rectal neuroendocrine tumor（RNET）.Methods it was retrospectively evaluated to review medical data of 58 patients with RENT.The clinical manifestations,pathological manifestations,diagnosis,treatment and prognosis were analyzed.Results there were 34 male and 24 female patients with average age（50.2±11.3）years.Main symptoms were bowel habit change,rectal bleeding.Pathological grading results were：G1 in 23（39.7%）cases,G2 in16（27.6%）,and G3 in 19（32.7%）.With immunohistochemical markers,all cases were positive for Syn,35（60.4%）cases were positive for CgA.18 cases were treated by endoscopic therapy,21 cases treated by annl surgery,19 cases radical surgery（14 for Dixon and 5 for Miles）.There were 52 patients receiving postoperative follow-up,and the median follow-up period was 29 months（5~48 mo）.During follow-up,two cases lymph node metastasis,five cases recurred,and three cases died.Conclusions Most RNET located in lower or mid part of rectum,and size was usually less than 2 cm.Pathologictype included RNET（G1,G2）,RNEC（G3）.RNET（G1,2）within size 1~2 cm may be managed by endoscopic or wide surgical excision if there is no evidence of muscularis invasion or lymph node metastasis.Low anterior resection or abdominoperineal resection is recommended for tumors2 cm as the risk of metastatic disease increases with tumors2 cm in size and with invasion of the muscularis propria.