CAJ | 학술논문

背景：直肠类癌属于神经内分泌肿瘤，临床上较少见。目前对直径1~2 cm的直肠类癌的治疗方式尚存在争议。目的：检测Ki-67在直肠类癌中的表达水平，探讨直肠类癌内镜切除治疗的疗效和安全性。方法：回顾性收集重庆三峡中心医院和武汉同济医院2008年1月至2013年12月期间确诊为直肠类癌，肿瘤直径＜1.5 cm、行内镜黏膜切除术的患者83例，分析其病例资料，并以免疫组化方法检测肿瘤组织Ki-67表达。结果：术前内镜超声检查显示83例患者肿瘤均位于黏膜层或黏膜下层，无固有肌层浸润或转移，术后平均随访38个月，无一例患者复发或转移。所有患者肿瘤组织Ki-67均呈低表达（0.84%±0.67%），肿瘤直径＜1.0 cm与1.0~1.5 cm组间性别、年龄、肿瘤部位、Ki-67表达水平差异无统计学意义（ P＞0.05）。以Ki-67指数均值0.84%为临界值分组，两组间各项临床病理参数差异亦无统计学意义（ P＞0.05）。结论：本组直径＜1.5 cm的直肠类癌Ki-67均呈低表达，提示肿瘤细胞增殖不活跃。对于直径＜1.5 cm、无固有肌层浸润或转移、Ki-67低表达的直肠类癌，内镜局部切除治疗安全、有效。
배경：직장유암속우신경내분비종류，림상상교소견。목전대직경1~2 cm적직장유암적치료방식상존재쟁의。목적：검측Ki-67재직장유암중적표체수평，탐토직장유암내경절제치료적료효화안전성。방법：회고성수집중경삼협중심의원화무한동제의원2008년1월지2013년12월기간학진위직장유암，종류직경＜1.5 cm、행내경점막절제술적환자83례，분석기병례자료，병이면역조화방법검측종류조직Ki-67표체。결과：술전내경초성검사현시83례환자종류균위우점막층혹점막하층，무고유기층침윤혹전이，술후평균수방38개월，무일례환자복발혹전이。소유환자종류조직Ki-67균정저표체（0.84%±0.67%），종류직경＜1.0 cm여1.0~1.5 cm조간성별、년령、종류부위、Ki-67표체수평차이무통계학의의（ P＞0.05）。이Ki-67지수균치0.84%위림계치분조，량조간각항림상병리삼수차이역무통계학의의（ P＞0.05）。결론：본조직경＜1.5 cm적직장유암Ki-67균정저표체，제시종류세포증식불활약。대우직경＜1.5 cm、무고유기층침윤혹전이、Ki-67저표체적직장유암，내경국부절제치료안전、유효。
BacKground:RectaI carcinoid is a rareIy seen neuroendocrine tumor. TiII now,there is controversiaI for the treatment modaIities of rectaI carcinoids with diameter between 1-2 cm. Aims:To study the expression of Ki-67 in rectaI carcinoids and the efficacy and safety of endoscopic resection. Methods:A totaI of 83 rectaI carcinoid patients with tumor diameter Iess than 1. 5 cm were enroIIed. AII patients were pathoIogicaIIy diagnosed and underwent endoscopic mucosaI resection from Jan. 2008 to Dec. 2013 at Chongqing Three Gorges CentraI HospitaI and Wuhan Tongji HospitaI. The medicaI records were retrospectiveIy reviewed and expression of Ki-67 in tumor tissue was assessed by immunohistochemistry. Results:AII patients underwent preoperative endoscopic uItrasonography. Tumors were Iimited to mucosa or submucosa, and no muscuIaris propria invoIvement or metastasis was seen. The mean foIIow-up duration was 38 months,and no recurrence or metastasis occurred. Ki-67 was IowIy expressed in aII rectaI carcinoids(0. 84% ± 0. 67%). When tumors were grouped by size,no significant differences in gender,age,tumor site and Ki-67 expression IeveI were seen between <1. 0 cm group and 1. 0-1. 5 cm group(P >0. 05). Furthermore,when tumors were grouped by a cutoff vaIue of mean Ki-67 index 0. 84%,differences in cIinicopathoIogicaI parameters between the two groups were not significant either( P >0. 05 ). Conclusions:Ki-67 is IowIy expressed in rectaI carcinoids Iess than 1. 5 cm in diameter enroIIed in this study,which denoted an inactive proIiferation. For rectaI carcinoids with diameter Iess than 1. 5 cm,with Iow Ki-67 expression and without muscuIaris propria invoIvement and metastasis, IocaI endoscopic excision is an effective and safe treatment modaIity.