胃肠道神经内分泌肿瘤52例诊治分析

目的：探讨胃肠道神经内分泌肿瘤(gastrointestinal neuroendocrine tumors，GI-NETs)的临床表现、诊治方法及预后的相关影响因素。方法：根据手术方法将2004年1月至2014年10月中南大学湘雅医院胃肠外科收治的52例GI-NETs患者(其中1例患者因身体情况差取消了手术)分为局部切除组(n=21)与经腹切除组(n=30)，对两组患者的临床资料、治疗方法及结果进行回顾性分析。结果：52例GI-NETs患者的临床表现均无特异性，多表现为局部侵袭或压迫症状。CT表现亦缺乏较特异的征象，直径大于1 cm的GI-NETs常表现为消化道壁的局部增厚、隆起、软组织块影，体积大者可见坏死，中度强化。52例标本免疫组织化学检测嗜铬粒蛋白A阳性率为63.5%，突触素阳性率为88.5%。除1例患者因身体情况差取消手术外，其余患者均经手术治疗，经腹切除共30例(57.7%)，内镜下或经肛局部切除共21例(40.4%)。全组患者中仅7例接受放射治疗和化学治疗。随访3~132个月，共7例死亡，其余均存活。局部切除组与经腹切除组的中位生存时间分别为39.5和43.0个月，差异无统计学意义(P>0.05)。结论：充分认识GI-NETs的生物学特征、早期诊断并及时进行个体化治疗，可望达到创伤小、生存期长的良好效果。

Diagnostic analysis for 52 cases of gastrointestinal neuroendocrine tumor

Objective: To investigate the clinical features, diagnosis, treatments and prognosis for gastrointestinal neuroendocrine tumors (GI-NETs).Methods: Clincal data of 52 patients, who were diagnosed as GI-NETs between January 2004 and October 2014, were reviewed. The patients were divided into a local excision group (n=21) and a transabdominal excision group (n=30), and the major clinical features, treatment modalities and outcomes were analyzed.Results: The clinical features of GI-NETs were nonspecific, and most of the clinical manifestation were local invasiveness. CT scan was lack of specific findings. GI-NETs greater than 1 cm often showed local incrassation, upheaval and soft tissue shadow. In the case of lager GI-NETs, necrosis and moderate enhancement could be seen. Positive ratio for expression of chromogranin A (CgA) and synaptophysin (Syn) in the 52 cases of specimen were 63.5% and 88.5%, respectively. Except 1 patient, whose surgery was canceled because of poor health, other 51 patients were treated with surgery through different approaches. Among them, 30 cases were transabdominal resection (57.7%) and 21 were local resection (40.4%). Chemotherapy and/or radiotherapy was only applied for 7 patients. After a follow-up of 40 (3–132) months, 7 patients died, the rest were alive. The median survival in the local resection group and the transabdominal resection group was 43.0 and 39.5 months, respectively (P>0.05).Conclusion: Under the condition of fully understanding the biological characteristics of GI-NETs, early diagnosis and timely personalized treatment is hopeful to reach the relative good prognosis and survival.