直肠神经内分泌癌16例临床分析

目的总结直肠神经内分泌癌（NEC）的临床病例资料与外科治疗策略。方法回顾性分析北京肿瘤医院2003-2007年经外科手术治疗16例直肠NEC患者的临床资料，并与同期经手术治疗的222例直肠腺癌患者的临床资料进行对比分析。结果16例直肠NEC患者占同期直肠恶性肿瘤392例的4．1％，其中非典型类癌10例，小细胞NEC3例，大细胞NEC3例。仅12．5％的患者术前血清癌胚抗原（CEA）升高；25．0％的患者行腹会阴联合切除术（APR），43．8％行低位前切除术（LAR），12．5％行联合脏器切除术，18．8％的患者肿瘤经肛门局部切除（LR）；有脉管癌栓者占37．5％，有淋巴结转移者占68．8％，43．9％的患者术中发现远处转移或肿瘤播散。222例直肠腺癌患者中，行根治性APR19．4％，行根治性LAR68．5％，行姑息性LAR5．4％，行结肠造口术2．7％，行剖腹探查术4．1％；有脉管癌栓者占20．7％，有淋巴结转移者占56．3％。直肠NEC患者术后1、2、3年的生存率分别为62．5％、25．0％和0．6％，明显低于直肠腺癌患者的83．1％、61．7％和46．1％（P〈0．01）。结论直肠NEC临床少见，较易发生脉管癌栓、淋巴结转移及远处脏器转移，生存率低于直肠腺癌；其外科手术原则与直肠腺癌相似。

Clinical analysis of rectal neuroendocrine carcinoma:a report of 16 cases

Objective To study the clinical data and surgical treatment strategy of rectal neurocndocrine carcinoma (NEC). Methods Sixteen cases of rectal NEC and 222 cases of metal carcinomas receiving surgical treatment in Beijing Cancer Hospital from 2003 to 2007, were analyzed retrospectively. Results Among the 16 rectal NEC patients, 4 (25%) received Miles surgery, 7 (43.8%) Dixon surgery, 2 combined multiple organ resection and 3 local resection. Lymph note metastases occurred in 11 cases(68.8%) and distant metastases in 7 cases (43.8%). Among the 222 rectal carcinoma patients, 43 (19.4%)received Miles surgery, 152 (68.5%)Dixon surgery, 12 palliative operation, 6 colostomy and 9 just received laparotomy. Lymph note metastases occurred in 125 cases (56.3%). In rectal NEC group, postoperative 1-, 2-and 3-year survival rates were 62.5%, 25.0% and 0.63% respectively, which were significantly lower than 83.1%, 61.7% and 46.1% in rectal carcinoma group (all P<0.01). Conclusions Rectal NEC is a rare disease. More vascular invasion, lymph node and distant organ metastases are found in rectal NEC than rectal carcinoma, and the prognosis of rectal NEC is worse than rectal cancer.