CAJ | 학술논문

目的探讨消化系统神经内分泌肿瘤(NEN)的诊断及治疗策略.方法回顾性分析2000年1月至2012年12月间大连医科大学附属第一医院收治的29例NEN患者的临床资料,依照新的WHO分类法对其治疗方式及预后进行重新评估.结果 29例患者中男19例,女10例,平均年龄46.5岁,全部病例均无类癌综合征的临床表现.所有病例均行手术治疗,其中2例胃神经内分泌癌分别行根治性全胃切除和根治性远端胃切除;3例位于十二指肠,其中2例为神经内分泌癌、1例为神经内分泌瘤,均行胰十二指肠切除;2例小肠神经内分泌癌均行小肠部分切除术;3例位于阑尾,其中1例神经内分泌癌行根治性右半结肠切除,2例神经内分泌瘤行阑尾切除术;1例升结肠神经内分泌癌行根治性右半结肠切除术;18例位于直肠,其中4例神经内分泌癌行经腹直肠癌前切除术或腹会阴联合直肠癌根治术,14例神经内分泌瘤则予以经腹直肠前切除术、经肛局部切除术或内镜黏膜切除术.全组13例神经内分泌癌患者术后1年生存率为38.4％,3年生存率为7.7％;16例神经内分泌瘤患者术后5年生存率为81.3％.结论消化系统NEN的临床表现无特异性,多位于直肠,手术治疗是有效的方法;神经内分泌癌预后较差,而神经内分泌瘤预后良好.
목적 탐토소화계통신경내분비종류(NEN)적진단급치료책략.방법 회고성분석2000년1월지2012년12월간대련의과대학부속제일의원수치적29례NEN환자적림상자료,의조신적WHO분류법대기치료방식급예후진행중신평고.결과 29례환자중남19례,녀10례,평균년령46.5세,전부병례균무유암종합정적림상표현.소유병례균행수술치료,기중2례위신경내분비암분별행근치성전위절제화근치성원단위절제;3례위우십이지장,기중2례위신경내분비암、1례위신경내분비류,균행이십이지장절제;2례소장신경내분비암균행소장부분절제술;3례위우란미,기중1례신경내분비암행근치성우반결장절제,2례신경내분비류행란미절제술;1례승결장신경내분비암행근치성우반결장절제술;18례위우직장,기중4례신경내분비암행경복직장암전절제술혹복회음연합직장암근치술,14례신경내분비류칙여이경복직장전절제술、경항국부절제술혹내경점막절제술.전조13례신경내분비암환자술후1년생존솔위38.4％,3년생존솔위7.7％;16례신경내분비류환자술후5년생존솔위81.3％.결론 소화계통NEN적림상표현무특이성,다위우직장,수술치료시유효적방법;신경내분비암예후교차,이신경내분비류예후량호.
Objective To investigate the diagnosis and treatment of neuroendocrine neoplasm (NEN) in the digestive system.Methods Clinical data of 29 patients with NEN from January 2000 to December 2012 in The First Affiliated Hospital of Dalian Medical University were analyzed retrospectively and the prognosis was evaluated according to the new WHO classification.Results There were 19 males and 10 females and the average age was 46.5 years.All the patients had no clinical manifestations of carcinoid syndrome,and they all received surgical treatment.Two cases were gastric neuroendocrine carcinoma (NEC),who received radical total gastrectomy and distal gastric resection respectively.Three cases had neoplasm in the duodenum,including 2 NEC and 1 neuroendocrine tumor (NET),and they all underwent Whipple's procedure.Two cases were small intestine NEC,who received partial small intestine resection.Three cases had neoplasm in the appendix,including 1 NEC treated with right hemicolectomy and 2 NET with appendectomy.One case was ascending colon NEC,who received fight hemicolectomy.Eighteen cases had neoplasm in the rectum,including 4 NEC treated with low anterior resection and abdominoperineal resection respectively,and 14 cases of NET underwent low anterior resection,local resection,and endoscopic resection respectively.The 1-and 3-year survival rates of 13 NEC cases were 38.4％ and 7.7％ respectively.The 5-year survival rate of 16 NET cases was 81.3％.Conclusions NEN of digestive system is located mainly in the rectum and the clinical symptom is unspecific.Radical resection of NEN is the preferred treatment.The prognosis of NEC is poor,and that of NET is better.