CAJ | 학술논문

目的探讨消化系统神经内分泌癌的临床病理特点及其诊疗.方法回顾性分析1985年1月至2008年3月间收治的38例消化系神经内分泌癌的临床资料.结果本组男29例,女9例.有黑便或便血21例(55%).腹痛19例(50%),腹部包块15例(39%),便秘14例(37%),直肠肿物12例(32%),腹胀11例(29%),大便次数增多或腹泻7例(18%).均采用手术治疗,其中1例行食管癌根治术,5例行根治性全胃切除.1例行姑息性近端胃切除术,2例行胃局部切除术,6例行胰十二指肠切除术,1例行胰体尾切除,3例行小肠部分切除术,7例行根治性右半结肠切除术,5例行经腹直肠癌前切除术,3例行腹会阴联合直肠癌根治术,4例行直肠局部切除术.36例患者获得3～144个月的随访,中位随访时间70个月,1、3、5年生存率分别为94.7%、86.8%和57.9%,中位生存期为62个月.肿瘤浸润深度超过肌层组的生存期[(36±5)个月]明显短于肿瘤浸润深度未超过肌层组[(73±5)个月](P<0.05).有淋巴结转移组的生存期[(34±7)个月]明显短于无淋巴结转移组[(74±5)个月](P<0.05).结论消化系统神经内分泌癌的临床表现无特异性,手术治疗是有效的方法.
목적 탐토소화계통신경내분비암적림상병리특점급기진료.방법 회고성분석1985년1월지2008년3월간수치적38례소화계신경내분비암적림상자료.결과 본조남29례,녀9례.유흑편혹편혈21례(55%).복통19례(50%),복부포괴15례(39%),편비14례(37%),직장종물12례(32%),복창11례(29%),대편차수증다혹복사7례(18%).균채용수술치료,기중1례행식관암근치술,5례행근치성전위절제.1례행고식성근단위절제술,2례행위국부절제술,6례행이십이지장절제술,1례행이체미절제,3례행소장부분절제술,7례행근치성우반결장절제술,5례행경복 직장암전절제술,3례행복회음연합직장암근치술,4례행직장국부절제술.36례환자획득3～144개월적수방,중위수방시간70개월,1、3、5년생존솔분별위94.7%、86.8%화57.9%,중위생존기위62개월.종류침윤심도초과기층조적생존기[(36±5)개월]명현단우종류침윤심도미초과기층조[(73±5)개월](P<0.05).유림파결전이조적생존기[(34±7)개월]명현단우무림파결전이조[(74±5)개월](P<0.05).결론 소화계통신경내분비암적림상표현무특이성,수술치료시유효적방법.
Objective To investigate the clinicopathologic features, diagnosis and treatment of neuroendocrine carcinoma(NEC)in the digestive system. Methods Thirty-eight patients with NEC from Jan 1985 to Mar 2008 were analyzed retrospectively and the related literatures were reviewed. Results There were 29 males and 9 females. Common symptoms were melena or hematochezia(n=21,55%),abdominal pain(n=19,50%),abdominal mass(n=15,39%),constipation(n=14,37%),rectal maas(n=12,32%),abdominal distention(n=11,29%)and diarrhea(n=7,18%).All the patients received surgical treatment including 1 esophagectomy,5 radical total gastrectomies,1 palliation proximal gastric resection,2 local gastric resections,6 pancreaticoduodenectomies,1 distal pancreatectomies,3 partial small intestine resections,7 radical right hemicolectomies,5 Dixon operations,3 Miles operations,and 4 local resections of rectal tumor. Thirty-six patients received follow-up.The follow-up time ranged from 3 months to 144 months(median,70months).The 1-,3-and 5-year survival rates were 94.7%,86.8%.and 57.9%respectively.The median survival time was 62 months.The survival time of the patients with carcinoma infiltration exceeding bowel muscularis propria was(36±5)months,significantly shorter than that of patients without carcinoma infiltration exceeding the bowel muscularis propfia[(73±5)monks,P<0.05].The survival time of the patients with positive lymph node metastasis was(34±7)months,significantly shorter than that of patients with negative lymph node metastasis[(74±5)months,P<0.05].Conclusions Clinical symptoms,signs of neuroendocrine carcinoma in the digestive system are nonspecific.The correct diagnosis should depend on histopathologic examination. Systematic treatments including radical resection of NEC are the preferable treatment.