胃肠道神经内分泌癌的临床病理特征和诊治分析

胃肠道神经内分泌癌（NEC）是一种相对罕见的胃肠道恶性肿瘤，临床表现复杂，早期极易误诊。目的：分析胃肠道NEC的临床病理特征、诊治方法和预后。方法：纳入2001年1月～2010年12月永州市中心医院北院收治的胃肠道NEC患者，对入组患者的临床和病理表现、诊治方法、预后进行回顾性分析。结果：共15例患者纳入研究，无一例患者有类癌综合征表现，组织病理学示溃疡型6例，结节型9例。神经元特异性烯醇化酶（NSE）、嗜铬粒蛋白A（CGA）、突触蛋白（SYN）阳性率分别为86．7％、53．3％、80．0％。患者术前误诊率达86．7％。所有患者均接受手术治疗，其中根治性全胃切除术3例，根治性远端胃大部切除术1例，小肠部分切除术4例，根治性右半结肠切除术3例，经腹直肠癌切除术2例，姑息性切除术2例。本组患者5年生存率为42．8％，中位生存期为53．7个月。肿瘤浸润深度超过肌层者的生存期显著低于浸润深度未超过肌层者（P〈0．01）；淋巴结转移者的生存期显著低于无淋巴结转移者（P〈0．01）。结论：胃肠道NEC的临床表现无特异性，确诊需依靠组织病理学检查。手术是治疗胃肠道NEC的有效方法。

Clinicopathological Characteristics, Diagnosis and Treatment of Gastrointestinal Neuroendocrine Carcinoma

Gastrointestinal neuroendocrine carcinoma （NEC） is a relatively rare malignant neoplasm, in which manifestations are complex and misdiagnosis is frequent in its early stage. Aims： To investigate the clinicopathological characteristics, diagnosis, treatment and prognosis of gastrointestinal NEC. Methods： A retrospective analysis was conducted on clinical manifestations, pathological findings, diagnosis, treatment and prognosis of patients with NEC who were enrolled from Jan. 2001 to Dec. 2010 at North Branch of Central Hospital of Yongzhou. Results： Fifteen eligible subjects were selected in this investigation. No manifestations of carcinoid syndrome was observed. Pathological types of these 15 cases were： 6 ulcerative types, 9 nodular types. The neuron-specific enolase （NSE）, chromogranin A （CGA） and synapsin （SYN） were positive in 86. 7%, 53. 3% and 80. 0% of the cases, respectively. The preoperative misdiagnosis rate was 86.7%. All the patients received surgical treatment, including 3 radical total gastrectomy, 1 distal subtotal gastrectomy, 4 partial small intestine resection, 3 right hemicolectomy, 2 rectal cancer resection via abdomen, and 2 palliative resection. The overall 5-year survival rate was 42.8%, and the median survival time was 53.7 months. The survival time of patients with carcinoma infiltration extending beyond muscularis propria was significantly less than those not exceeding muscularis propria （P 〈 0.01 ）. The survival time of patients with lymph node metastasis was significantly less than those without lymph node metastasis （ P 〈 O. 01 ）. Conclusions： The clinical manifestations of gastrointestinal NEC are not specific, pathological examination is the key for making diagnosis, and surgical operation is an effective treatment for gastrointestinal NEC.