原发性消化道黑色素瘤的临床分析

目的 总结原发性消化道黑色素瘤的临床特点。方法 回顾性分析我院近10年住院治疗的8例原发性消化道黑色素瘤临床资料并复习献。结果 8例原发性消化道黑色素瘤中，原发灶位于直肠6例，小肠1例，食管1例，除1例直肠黑色素瘤术前得到确诊外，其余7例均被提诊，直肠黑色素瘤以便血，肛门疼痛和排便困难为主要症状；多表现为息肉样，均位于距齿状线以上5cm以内；少有色素沉着，小肠黑色素瘤以梗阻，腹痛，贫血为主要症状；造影和CT有助于发现病变，但确诊仍需病理学，食管黟 以素瘤多为黏膜下；胃镜可发现色素沉着；病理活检可协肋诊断。结论 原发性消化道黑色素瘤的临床表现与其他肿瘤类似，极易误诊，病理活检是确诊的主要手段。     

23例消化道类癌临床分析

目的 探讨消化道类癌的诊断和治疗。方法 对我院1992年10月至2002年12月收治的23例消化道类癌患者的临床资料进行回顾性分析。结果 23例消化道类癌中3例胃类癌，1例十二指肠类癌，4例阑尾类癌，3例结肠类癌，12例直肠类癌。术前9例(39％)经活检确诊；术后经病检23例中11例(47．8％)浸润程度超过肌层；4例(17．4％)有区域淋巴结转移；8例经神经元特异性烯醇酶(NSE)检查(此酶为神经内分泌肿瘤的重要标志物，具有诊断价值)有6例阳性表达，表达阳性率为75％。结论 病变部位、浸润深度、淋巴结转移是决定消化道类癌预后的关键因素。手术是有效的治疗方式。     

直肠类癌临床病理分析及内镜治疗(附38例)

目的 探讨直肠类癌的临床病理学特点及治疗方法.方法 回顾性分析38例直肠类癌的临床病理资料.结果 38例均为典型性类癌,均位于距肛门10 cm以内.内镜下多表现为典型的黏膜下肿物,色黄、质硬或韧,活动度差.所有病例神经内分泌分化标记物染色阳性.直径≤2 cm者34例,其中30例位于黏膜内,4例侵犯黏膜下层,内镜下行黏膜切除术治愈;4例直径>2 cm,均侵犯肌层,行直肠癌根治术.肿瘤≤2 cm者Ki-67阳性表达率<3%或阴性.34例获随访,均存活.结论 直肠类癌明确诊断依赖于组织病理学观察及免疫组化.直肠类癌生物学行为低度恶性,一般不侵犯肌层,也很少转移,多数病例可在内镜下行黏膜切除术治愈.     

直肠类癌临床病理分析及内镜治疗(附38例)

目的 探讨直肠类癌的临床病理学特点及治疗方法.方法 回顾性分析38例直肠类癌的临床病理资料.结果 38例均为典型性类癌,均位于距肛门10 cm以内.内镜下多表现为典型的黏膜下肿物,色黄、质硬或韧,活动度差.所有病例神经内分泌分化标记物染色阳性.直径≤2 cm者34例,其中30例位于黏膜内,4例侵犯黏膜下层,内镜下行黏膜切除术治愈;4例直径>2 cm,均侵犯肌层,行直肠癌根治术.肿瘤≤2 cm者Ki-67阳性表达率<3%或阴性.34例获随访,均存活.结论 直肠类癌明确诊断依赖于组织病理学观察及免疫组化.直肠类癌生物学行为低度恶性,一般不侵犯肌层,也很少转移,多数病例可在内镜下行黏膜切除术治愈.     

直肠类癌的临床诊断与治疗分析

为探讨直肠类癌的临床特点、诊断、治疗及预后,回顾分析26例直肠类癌患者的临床资料,并进行随访。结果显示,26例患者中,男性多于女性;平均年龄51岁;肿瘤位于距肛缘8cm以内直肠为21例（80．8％）;主要临床表现为肛周坠胀不适（4例）、大便带血（10例）、排便习惯改变（7例）、不完全性肠梗阻（1例）,无症状者健康体检时发现（4例）;诊断主要依赖于直肠指检、直肠镜检查、电子结肠镜检查及活检结果;26例均行手术治疗且经术后病理证实;术后5年生存率76．9％（20／26）。结果表明,直肠指检对发现直肠类癌有重要作用,影响直肠类癌预后的主要因素为肿瘤大小、肿瘤的浸润及转移情况;早期诊断及早期个体化的手术是治疗本病的关键。     

胃肠道类癌

为探讨胃肠道类癌的临床诊断、治疗和病理学特点。对６２例胃肠道类癌进行了系统的病理组织学观察及总结，其中４６例行局部切除，１６例做了根治性手术，随访１～１０年，死亡４例。作者认为：病理学诊断是类癌最后确诊的主要方法，手术切除的范围取决于原发肿瘤的大小、部位、浸润程度、淋巴结受累及有无肝转移情况     

胃类癌的临床与病理分析

目的探讨胃类癌的诊断、病理学特点及治疗选择。方法对1980～2000年经手术和病理诊断的胃类癌22例临床资料进行分析总结。结果22例中8例术前经胃镜活检确诊,3例术中经快速病理诊断,11例为术后病理证实。全组均予手术治疗,其中2例行局部切除,8例行胃大部切除术,10例为根治性胃大部切除术,1例为全胃切除术,1例做了全胃切除加肝左叶切除术。随访1～10年,死亡9例,其中6例死于类癌复发伴广泛转移;1例伴有胃腺癌者死于胃腺癌复发和转移;1例术后经支气管镜证实合并支气管类癌,而后死于肝转移。结论胃镜检查是术前发现胃类癌的重要手段,病理学诊断是最后确诊的主要方法。胃类癌的治疗取决于肿瘤的大小、浸润程度及生物学行为     

胃类癌的临床、生物学行为特点及外科治疗（附16例报告）

目的探讨胃类癌的临床、生物学行为特点及治疗选择。方法对1980—2002年经病理证实的胃类癌16例临床资料进行分析总结．结果16例中5例术前经胃镜活检确诊，2例术中经快速病理诊断，9例为术后病理证实。有淋巴结转移者7例，其中6例直径大于2cm。全组均予手术治疗，其中1例行内镜下电灼切除术，4例行局部切除术，1例行胃大部切除术，6例行根治性胃大部切除术，3例行根治性全胃切除术，1例行姑息性胃大部切除术及肝固有动脉结扎术。随访1—10年，死亡6例，其中5例死于类癌复发伴广泛转移．结论胃镜检查是术前发现胃类癌的重要手段，病理学诊断是最后确诊的主要方法．胃类癌的大小对判断其良恶性有重要参考意义．术式选择应根据肿瘤大小、浸润程度、有无淋巴结及肝转移而定。     

直肠类癌

为探讨直肠类癌的病理学特点,诊断及治疗选择,对我院１９８７－１９９７年１０年间收治的２６例直肠类癌病例进行回顾性总结。２６例术前均行直肠镜检查并经病理学检查而确诊,其中１９例分别做了局部切除或局部扩大切除,７例因肿块直径大于２ｃｍ而行根治术性手术。术后随访１－１０年,死亡５例,作者认为,直肠镜检查是术前发现直肠类癌的重要手段,对可疑病变行活检时,除常规行ＨＥ染色外,应加做嗜银染色,亲银染色以及免疫     

儿童阑尾类癌的临床与病理特点分析（附1例报告及文献复习）

目的提高对儿童阑尾类癌临床与病理学特点的认识。方法分析1例9岁女孩阑尾类癌临床与病理组织形态学及瘤细胞的免疫组织化学特点，并结合文献复习。结果患儿急性化脓性阑尾炎切除标本中发现阑尾远端肿块经HE及免疫组化确诊为阑尾类癌。结论本文就儿童阑尾类癌的临床表现、发生部位、病变特点、病理组织学分型、诊断、治疗进行讨论；阑尾类癌在儿童一般预后良好。     

高频超声小探头辅助内镜下粘膜切除术治疗微小直肠类癌的回顾性分析

目的归纳直肠类癌内镜超声图像特征与染色放大内镜腺管开口形态特点,探讨高频超声小探头辅助内镜下粘膜切除术(endoscopic mucosal resection,EMR)治疗微小直肠类癌的安全性、可行性。方法37例直肠隆起性病变,予内镜下观察病灶腺管开口,小探头高频超声探测病灶来源、大小、性质及浸润性;其中29例行EMR。结果共8例经病理检查确诊为直肠类癌,平均病变直径(6.25±2.46)mm,内镜下扁平或轻度隆起,呈黄白色,表面粘膜正常,腺管开口Ⅰ型,超声内镜下表现为低回声团影,多局限于粘膜下层,不侵犯固有肌层,未探及直肠周围淋巴结,病理均显示残端肿瘤完全切除。操作过程顺利,无穿孔和大出血等严重并发症出现,随访6~54月,未见一例复发、转移,但1例死于结肠癌。结论高频超声小探头检查可初步明确病变来源及层次,可安全有效地指导直肠微小类癌EMR的治疗。     

直肠类癌36例临床分析

为探讨直肠类癌的临床特点及手术治疗方法,分别对36例直肠类癌患者行手术治疗,瘤体（长径）〈1．0cm者行局部切除治疗,瘤体≥1．0cm者行开腹手术治疗。结果显示,本组36例患者中,瘤体〈1.0cm者32例（88．9％）,瘤体距肛缘3～8cm者32例（88．9％）,男女比例1．25：1,误诊9例（25．0％）,成功随访30例（83．3％）,死亡2例,其他均无复发及转移。结果表明,直肠类癌瘤体的大小、有无肌层浸润是选择手术方法的依据,对于直肠类癌长径〈1．Ocm者行局部切除即可治愈。     

直肠类癌诊治46例报告

为提高直肠类癌的诊疗水平，同顾分析46例直肠类癌患者资料，通过访问病史、症状体征检查，尤其是指诊和结肠镜检查，结合病理明确诊断，最终行手术治疗。结果显示，肿物局部切除42例；3例直肠镜下活检完整取出病灶；经腹会阴根治术1例，尔后病理检查显示类癌恶变．有淋巴结转移，死于肝转移。45例健在。结果表明，直肠类癌属于肛肠疾病中较少见的一种，可以恶变，因此提高早期对该病的认汉和及时行相关检查并处理至关重要，手术治疗后需要定期随访。     

Long-term survival following bronchotomy for polypoid bronchial carcinoid tumours

Objective: Typical bronchial carcinoids are very low grade neuroendocrine neoplasm of the tracheobronchial tree and have very good results in surgical treatment. Surgical treatment varies from bronchotomy-excision to major resective procedures. We presented our results of bronchotomy, simple excision and long-term follow-up. Methods: In Atatürk Centre for Chest Disease and Chest Surgery, 16 patients with bronchial carcinoid tumour underwent bronchotomy-excision over a 23-year-period. In all of the cases tumours were in polypoid type. Except these 16 cases 51 patients with bronchial carcinoids underwent operations in the same period. Presenting symptoms were haemoptysis, cough, recurrent pulmonary infection, dyspnea and chest pain. Rigid bronchoscopies were performed on all of the patients preoperatively for diagnosis of the tumour and to determine the surgical procedure and we performed control bronchoscopies on all of the patients in their follow-up period. Results: Patients were checked for periods ranging from 2 to 23 years both radiologically and bronchoscopically. We did not find any recurrences and death related to surgery and morbidity rate were minimal. Conclusion: We think that bronchotomy and simple excision are effective and safe procedures for the treatment of bronchial carcinoid tumours with low morbidity in selected cases like polypoid type lesions and have as good a long-term survival rate as the other surgical treatment methods have.     

19例直肠类癌临床资料回顾性研究

目的探讨直肠类癌的临床特点及诊治方案。方法对2008年6月至2012年8月期间我院收治的19例直肠类癌患者的病历资料进行回顾性研究。结果4例表现出排便习惯改变或便血症状,1例无症状者体检时发现直肠硬结,14例因其它肛肠疾病就诊时通过直肠指诊或乙状结肠镜检查偶然发现直肠肿物;19例类癌均〈1．0cm,直肠腔内超声检查见肿物局限于黏膜下层,均经肛门或内镜下局部切除,术后随访未见复发。结论部分直肠类癌无明显症状,直肠指诊和乙状结肠镜检查是发现直肠类癌的重要方法,直肠腔内超声检查可作为直肠类癌鉴别诊断及术前评估的主要手段,对于直径〈1．0cm的直肠类癌,经内镜或经肛门局部切除是安全有效的。     

Rectal carcinoids as tumors of the hindgut endocrine cells: a morphological and immunohistochemical analysis

The rectal mucosa is richly endowed with a constellation of amine and polypeptide hormone-producing endocrine cell types which may be identified by silver staining and immunohistochemical methods. In order to study the relationships of rectal carcinoid tumors to the normal hindgut endocrine cells, rectal carcinoids and normal rectal mucosa were compared for the presence of argentaffinity and argyrophilia and for the distribution of a battery of polypeptide hormones. Normal rectal mucosa contained frequent cells which stained for bovine pancreatic polypeptide (PP), human PP, and glucagon-like immunoreactivity (GLI. Somatostatin (SRIF) was present in a smaller proportion of rectal endocrine cells. Both argentaffin and argyrophil cells were encountered frequently in normal rectal mucosa. In the series of 13 rectal carcinoids examined, two cases were focally argentaffin-positive, while eight tumors revealed varying degrees of argyrophilia. Eight tumors contained immunoreactive bovine PP, and four of these tumors which were tested for human PP were also positively stained. SRIF was present in five cases, while GLI was identified in two tumors. Four of the tumors were multihormonal. Rectal carcinoids have a rich polypeptide hormone content which parallels that of the normal rectal mucosa. The distinctive hormonal profile and silver staining properties may prove to be of value as specific markers for carcinoid tumors of rectal or hindgut origin.     

内镜黏膜下剥离术治疗直肠类癌

目的探讨内镜黏膜下剥离术（ESD）治疗直肠类癌的应用价值。方法肠镜发现直肠黏膜下肿块后进行微探头超声检查，对诊断为类癌者应用头端弯曲的针形切开刀进行内镜黏膜下剥离术治疗：（1）黏膜下注射生理盐水抬高病灶，使病灶与肌层分离；（2）预切开病灶周围黏膜；（3）剥离病变下方黏膜下层结缔组织，完整切除病灶。结果5例直肠类癌患者，肿瘤直径0.4～1.2（平均1．1）cm，均成功完成ESD治疗。ESD手术时间（自黏膜下注射至完整剥离病变）20-45（平均35）min；术中创面少量出血，均经电凝、氩离子血浆凝固和止血夹成功止血。不需再次肠镜下止血。1例剥离深至肌层，出现皮下气肿，保守治疗好转。术后全部经病理确诊。基底和切缘未见病变累及。1个月后肠镜复查，创面基本愈合。结论ESD是治疗直肠类癌的新方法．以往需要外科手术切除的肿瘤通过ESD可以达到同样的治疗效果。     

低位直肠类癌的外科治疗体会

为探讨低位直肠类癌的治疗方法,回顾分析8例低位直肠类癌局部切除患者的资料。结果显示,8例患者中,除1例多发类癌患者外,其余肿瘤均距肛缘7cm以内;肿瘤直径〈1cm者7例,≥1cm者1例。术后定期复查,均无复发。结果表明,低位直肠类癌早期肿瘤局限,瘤体小,行局部切除术预后较好;对于瘤体较大者需要谨慎对待。术后应定期复查。     

Viability of Endoscopic and Excisional Treatment of Early Rectal Carcinoids

With the advent of endoscopy, the incidence of rectal carcinoid tumors has not only risen, but the majority are localized at presentation. This has led to excisional and/or ablative therapy in lieu of radical resections. A single institute’s experience with rectal carcinoids was reviewed to determine the impact this approach has had on outcomes, and evaluate any selection criteria for optimizing patient survival. A single institute’s tumor registry was retrospectively queried, identifying 14 patients with rectal carcinoid tumors over a 28-year period. The mean age at diagnosis was 52.1 ± 14.4 years. Six of the 14 patients were female. Presenting symptoms included a change in bowel habits in six (38%), rectal bleeding in six (38%), and abdominal pain or distention in five (31%) patients. No patient had symptoms consistent with carcinoid syndrome. The rectal carcinoids were a mean 9.2 ± 3.4 cm from the anal verge and a mean 9 ± 6 mm in size. Endoscopic and/or transanal excision/fulguration techniques treated 11 (79%) patients, whereas two (14%) patients underwent a low anterior resection (LAR). Surveillance entailed periodic endoscopy for a median 65 months (range 8–281). No patient developed recurrent carcinoid disease for a 20-year overall survival of 70%. Poster Presentation (103184). Digestive Disease Week, May 20, 2002, San Francisco, CA.