24例小肠神经内分泌肿瘤的诊治体会

24例小肠神经内分泌肿瘤的诊治体会

【摘要】目的探讨小肠神经内分泌肿瘤的临床特点、治疗方法及预后。方法回顾

性分析南昌大学第一、二附属医院收治的24例小肠神经内分泌肿瘤患者的临床诊疗和随访资料。

结果分期情况：T1期7例、T2期4例、T3期4例、T4期6例，另3例无法确定。分级情况：G1级10

例，G2级7例，NEC 5例，MANEC 2例。免疫组化Syn、CgA、NSE阳性表达率分别为95%、79%、75%。

临床表现：上腹疼痛17例、溃疡出血2例，胆系扩张、梗阻性黄疸、瘙痒5例，恶心呕吐、贫血

等3例，类癌综合症1例，无症状1例。治疗：18例十二指肠NETs患者中内镜下切除6例，全身姑

息化疗1例，胰十二指肠切除11例，其中术后辅助化疗6例；6例空回肠NETs患者中手术切除3例，

肝转移灶介入后再行小肠病灶手术切除1例，对症治疗2例。随访：6例内镜下切除者均无病生存，

11例十二指肠NET患者术后1例死于心脏疾病，1例死于肺部感染，其余仍存活。未行手术治疗的

1例NEC患者和2例MANEC患者存活期较短，分别为5个月，13个月，10个月。6例空回肠NETs患者

有2例仍然存活，其余4例出现腹腔、肝内广泛播散，均在2年后死亡。结论小肠神经内分泌肿

瘤缺乏特征性临床症状，内镜有助于该病的早期诊断。尽早手术切除肿瘤，可提高患者生存率，

病理分期和分级与患者的生存预后密切相关。

【关键词】小肠神经内分泌肿瘤；诊断；治疗；预后

objective : To analyze the clnical features 、therapies and prognosis of intestinal neuroendocrine neoplasms Methods: The clinical diagnosis and treatment data of 24 patients with intestinal neuroendocrine neoplasms admitted to Number1 and Number2 affiliated hospital of Nanchang University were retrospectively analyzed.

Result:As for stages,there were 7 cases of T1, 4 cases of T2, 4 cases of T3,6 cases of

T4,and 3 cases unable to confirm. There were 17 cases of neuroendocrine tumor (NET) (10 cases of G1 and 7 cases of G2), 5 cases of neuroendocrine carcinoma (NEC) and 2 cases of mixed adenoneuroendocrine carcinoma (MANEC).Syn, CgA and NSE positive expression rate were 95%, 79% and 75% respectively.Clinically there were 17 cases represented epigastric discomfort or pain , 2 cases represented ulcerc and bleeding, 5 cases represented gallbladder extention 、obstructive jaundice and pruritus, 3 cases represented nausea 、vomiting and anemia,1 case without any symptomas,and only 1 case represented carcinoid syndrome.In the 18 cases duodenum neuroendocrine neoplasms,6 patients underwent endoscopic excision,1patient underwent palliative chemotherapy,11patients underwent pancreaticoduodenectomy,in which there were 6 cases accepted chemotherapy after surgery.Among the 6 jejunum and ileum neuroendocrine neoplasms, 3 patients underwent surgical treatment, 1 patient underwent small intestine lesion resection after Liver intervention,another 2 cases accepted supportive theatment.The follow-up result is the 6 patients who underwent endoscopic excision all are alive.After surgery,1of the 11 duodenum neuroendocrine neoplasms died of heart disease,1patient died of pulmonary infection, others still

alive.But the NEC patient and another 2 MANEC patients survive short time ,they lived 5 months、13 minths、10 months respectively. As for jejunum and ileum neuroendocrine neoplasms, 2 cases are still alive,another 4 all died after 2 years because of peritoneal or liver transferation metastases

Conclusion: The endoscope and CT help to diagnosis intestinal neuroendocrine neoplasms early,accept surgery as soon as possible can increase patient’s survival rate. KEY WORDS intestinal neuroendocrine neoplasms;diagnosis ;Treatment; Prognosis 小肠神经内分泌肿瘤是一类起源于肠壁肽能神经元和神经内分泌细胞的异质性肿瘤，其发

病率低，早期症状缺乏特异性。近几年，其发病率和检出率呈上升趋势。调查显示：在过去的

35年，小肠神经内分泌肿瘤的发病率增加了300%-500%[1]。为提高对小肠神经内分泌肿瘤的认识