消化道类癌治疗的临床研究——附56例报告

本文分析３４年来收治的消化道类癌５６例（直肠３６例、胃１４例、阑尾３例、食管２例、十二指肠１例），探讨其临床生物特性，比较不同部位类癌、肿瘤大小及转移情况。结果表明：（１）胃类癌的发病年龄高于直肠和阑尾；（２）直肠和阑尾类癌常〈２ｃｍ，而胃、食管类癌常〉２ｃｍ；（３直肠类癌局限在粘膜下层，而胃、阑尾类癌易浸润至浆膜层；（４）胃类癌的淋巴转移高于直肠和阑尾；（５）不同部位消化道类癌的生物学行为不同；     

消化道类癌38例的临床分析

目的总结消化道类癌的临床特点和诊治方法。方法回顾性分析我院2008年1月至2012年1月诊断的38例消化道类癌患者的临床资料,总结消化道类癌的临床表现,内镜及超声内镜特点及治疗和随访情况。结果消化道类癌的临床表现有:上腹不适(10/38),腹痛(7/38),腹泻(3/38),便血(2/38),排便习惯改变(12/38),左下腹不适(4/38);其中出现类癌综合征患者3例,均合并有肝转移。发病部位:食管1例,胃7例,小肠2例,回盲部2例,横结肠1例,乙状结肠1例,直肠24例。消化内镜检查发现病变37例,超声内镜检查33例(病变位于黏膜固有层或黏膜下层),腹部增强CT检查38例(其中小肠病变2例伴肠系膜转移,肝转移瘤3例)。经内镜下切除24例(病变直径<10mm,胃2例,直肠22例),手术治疗14例(食管1例,胃5例伴肝转移1例,小肠肿物伴肠系膜转移2例,回盲部2例,横结肠1例伴肝转移1例,乙状结肠1例,直肠2例伴肝转移1例);术前病理诊断类癌33例,5例为术后病理证实。结论消化道类癌临床表现缺乏特异性,合并肝转移患者可出现类癌综合征;消化道类癌内镜下组织活检进行免疫组化的病理诊断率很高;超声内镜是提高类癌拟诊及指导内镜下切除类癌病变的重要检查手段;内镜下病变切除及外科手术治疗是类癌的重要治疗手段。     

胃肠道内分泌肿瘤

胃肠道内分泌肿瘤并不少见,它又统称APUD细胞瘤(Apudoma),可发生在胃肠道本身或胰腺,胃肠道以类癌最多见,胰腺主要有胰岛素瘤、胰高糖素瘤、胃泌素瘤、血管活性肠肽瘤、生长抑素瘤、胰多肽瘤,以及多发性内分泌肿瘤等,现分述如下。 一、类癌(Carcinoid) 类癌又称嗜银细胞瘤(Argentaffinoma),可见于消化道的任何部位,以阑尾的发生率最高,其次为回肠、直肠、胃、十二指肠和空肠,胃肠道以外的类癌较少见。 (一)病理 类癌常为粘膜下小结节,直径多在1.5cm以     

消化道类癌的内镜诊治及临床分析

目的:探讨消化道类癌的内镜病理特点以及内镜下治疗方法。方法:对1995年1月至2006年10月确诊的23例消化道类癌患者的临床资料进行回顾性总结分析。结果:23例类癌中,位于食管5例(21.7%),胃体6例(26.1%),直肠9例(39.1%),贲门、十二指肠球部及乙状结肠各1例(各占4.3%),1例为直肠多发分布。5例食管类癌均为隆起型病灶,直径0.8～2.5cm,表面糜烂,边界清楚,6例胃类癌中2例为直径0.5～1.0cm宽基息肉样,表面糜烂,4例为溃疡浸润性肿物,边界不清,病变2cm以上,最大者6cm×8cm。十二指肠1例类癌呈0.3cm光滑结节;直肠9例类癌,3例表现为0.5～1.0cm宽基息肉样隆起,其余均为典型黏膜下病变,呈半球状隆起,表面黏膜光滑,淡黄色或稍充血,实质感;直径0.8～1.2cm,同时检出伴腺瘤性息肉1例,多发类癌1例。乙状结肠1例为0.5cm×1.0cm隆起,表面黏膜破坏,术后经病理证实。结论:胃肠镜检查是消化道类癌早期发现的重要手段,内镜超声及病理学、免疫组化检查是确诊方法,而内镜下黏膜切除术是微创治疗早期低度恶性消化类癌的首选。     

胃肠道类癌诊治与预后因素分析

目的：探讨胃肠道类癌的诊治方法及影响预后的相关因素。方法：对50例胃肠道类癌病人的临床、病理及随访资料进行回顾性分析。结果：32％的胃肠道类癌病人有腹痛,30％出现腹胀,未发现类癌综合征病例。术前48％的病人经胃镜或结肠镜检查确诊。直肠类癌占38％,胃类癌及十二指肠类癌各占20％。所有病人均经手术完整切除。肿瘤直径平均为2．70±1．79cm,24％的肿瘤浸及浆膜层,伴淋巴结转移者占20％。中位随访时间72个月,5年生存率占54％。平均生存期为（67．2±18．9）个月,其中肿瘤直径不超过2．70cm者为（80．4±5．0）个月,超过2．70cm者为（80．4±5．0）个月;肿瘤浸润深度不超过肌层者为（76．3±3．1）月,肿瘤侵及浆膜者为（51．2±5．8）月;伴有淋巴结转移者为（50．2±4．6）个月,不伴淋巴结转移者（76．5±4．7）个月。生存分析提示肿瘤直径、浸润深度及淋巴结转移影响患者预后。结论：消化道类癌有效的治疗手段为完整切除。肿瘤大小、浸润深度及淋巴结转移与预后有关。     

直肠类癌病理误诊为腺癌分析(附二例报告)

神经内分泌癌(类癌的一种)为神经内分泌肿瘤中的少见类型,高度恶性,以中老年人多见[1]。直肠是消化道神经内分泌肿瘤的好发部位之一,肿瘤较小时一般无症状,肿瘤较大时无特殊的临床表现,但很少发生类癌综合征[2],诊断主要依靠病理检查.我院收治2例直肠类癌,现报告如下。1病例资料【例1】女,75岁。因发现直肠上段肿物1个月入院,手术切除部分肠管及肿物。大体标本:一段长13 cm、周长10 cm的肠管,距上下切缘4 cm处各有一呈两叶的息肉状肿物,向肠腔内突出生长,大小分别为5·0 cm×3·5 cm×3·5 cm;2·8 cm×2·5 cm×2·0 cm,两叶共有一短粗的蒂…     

直肠小细胞神经内分泌癌1例报道

消化道神经内分泌癌是一组少见肿瘤,其中类癌较多,小细胞癌少见.而后者又以食管、胃等上消化道多发,肠道罕见,尤其发生于直肠者近年文献鲜有报道.本文结合我院1例直肠小细胞神经内分泌癌进行文献复习,探讨其临床病理特点、诊断及鉴别诊断.     

1021例消化道早癌及癌前病变患者临床分析

目的 分析消化道早癌及癌前病变患者的临床和病理特征。方法 回顾1021例消化道早癌及癌前病变患者临床资料,对其发病部位、病灶特征和病理结果等进行分析。结果 共收集病例1021例,男女比例为1.60:1,发病部位分布范围自食管至直肠均有发现,食管、胃、结直肠和十二指肠中,于结直肠发现例数最多[82.86%(846/1021)];按详细部位排列,最多位于乙状结肠,其次为横结肠、升结肠、直肠、胃窦、食管、降乙交界、降结肠、直乙交界、盲肠、结肠脾区、胃体、结肠肝区、十二指肠、贲门、胃底、幽门,大部分病灶尺寸<1 cm,占57.88%,所有病灶中以Ⅰ型病灶为主;LST(侧向发育型肿瘤)病灶好发于右半结肠;所有病理结果中,高级别瘤变占比50.44%,检出最多位于乙状结肠;原位癌比例仅占7.15%,在直肠及直乙交界检出最高。结论 消化道早癌及癌前病变的发现范围分布自食管至直肠,结直肠检出比例高,最常见于乙状结肠,LST好发于右半结肠,原位癌不易被发现。     

直肠类癌的诊断与治疗

目的　探讨直肠类癌的诊断、病理学特点、外科治疗方法的选择及预后因素。方法　回顾性分析 1987～ 2 0 0 2年收治的 11例直肠类癌的临床病理资料。结果　所有病例术前均行直、乙状结肠镜检查 ,并活检 ,其中 5例术前确诊为直肠类癌。所有病例肿瘤距肛缘均≤ 8cm。肿瘤直径 <1cm者 3例 ,均无肌层浸润 ;肿瘤直径 >2cm者 5例 ,均有肌层浸润。免疫组化分析结果显示 :11例NSE呈阳性 ,10例CgA呈阳性 ,4例SYN呈阳性。局部切除术及电灼术共 3例。根治性手术 7例。术后随访 7～ 192个月 ,2例死于肝转移。最长存活时间为 192个月。结论　直肠指诊和直、乙状结肠镜检查是诊断直肠类癌最简单有效的手段。对可疑病变行活检时 ,除常规HE染色外 ,应加做免疫组化检查。手术切除是最佳的治疗方法。肿瘤大小及浸润深度是决定手术方式和预后的主要依据     

类癌15例临床特点分析

目的：分析近12年15例类癌的临床特征．以提高对该疾病的认识及诊治水平。方法：统计1994年3月至2006年3月本院收治的15例类癌患者的临床资料．分析其发生部位、临床表现、诊断及治疗方法。结果：（1）12年间住院患者中类癌共15例，以消化道类癌多见。（2）10例消化道类癌包括胃类癌4例，直肠类癌4例，结肠类癌2例。（3）10例消化道类癌均经病理诊断证实，确诊时间中位数为9个月，2例出现局部淋巴结转移。（4）10例消化道类癌8例直径小于2cm，4例合并良性息肉生长。（5）4例患者内镜下切除类癌，2例复发接受手术治疗，另6例中5例接受手术治疗。结论：（1）类癌临床诊断率很低，诊断过程长。（2）消化道类癌恶性度低，远处转移少。（3）类癌临床症状缺乏特异性．确诊依靠病理检查。     

Carcinoid tumors of the gastrointestinal tract: a 44-year experience

We retrospectively studied 112 patients treated for gastrointestinal carcinoid tumors between 1942 and 1986. The three most common sites were jejunum-ileum (27%), rectum (27%), and appendix (21%), followed by colon (12%), duodenum (9%), and stomach (4%). Seventy-five percent of patients had localized disease, primarily in the rectum and appendix. Colon and small bowel tumors were often manifested with metastatic disease. Complete surgical excision of all localized disease was curative in 94% of patients. Corrected five- and ten-year survival rates were 90% and 58%, respectively, in cases of localized disease, whereas in stage III disease, the rates were 46% and less than 30%, respectively. All patients with liver metastasis died within 25 months. A second malignancy, most often adenocarcinoma of the colon, occurred in 25% of patients. Carcinoid syndrome was found in 6% of patients. The best survival rates were noted for appendiceal and rectal carcinoids, and the worst for colon and stomach carcinoids.     

Clinical study of 81 gastrointestinal carcinoid tumors.

The behavior and treatment of gastrointestinal carcinoid tumors have been the subject of much discussion. Size, location, and histologic invasiveness have been shown to correlate with regional and remote metastasis in previous series. We reviewed 81 patients with gastrointestinal carcinoids seen at the Medical University of South Carolina Teaching Hospitals since 1950. An unusual case of a 0.5 cm primary ileal carcinoid with widespread intra-abdominal and hepatic metastases is documented. In this series carcinoids were found (in order of decreasing frequency) in the ileum, appendix, rectum, right colon, duodenum, jejunum, stomach, ampulla of Vater, sigmoid colon, and pancreas. Metastases were found in 17% of the overall group. Two carcinoids presented with intussusception, while one was found within a Meckel's diverticulum. In addition to the small metastatic ileal carcinoid, one patient with a rectal carcinoid measuring 0.4 cm was found to have metastases after low anterior resection. Because all extra-appendiceal gastrointestinal carcinoids are potentially metastatic, it is stressed that regional lymphadenectomy en bloc with primary excision is the treatment of choice wherever feasible. If the lesion is small or has not invaded deeply, local excision with close follow-up may be an acceptable alternative.     

Atypical endoscopic features of rectal carcinoids

BACKGROUND AND STUDY AIMS: It is not normally difficult to diagnose carcinoid tumors (well-differentiated endocrine neoplasms) of the rectum endoscopically, as they usually have a characteristic appearance. However, little is known about the atypical endoscopic findings in some rectal carcinoids and the present study was performed to analyze these. PATIENTS AND METHODS: The endoscopic findings in 67 consecutive patients with rectal carcinoids (37 men, 30 women; age range 23 - 76) were analyzed retrospectively. RESULTS: Tumor size ranged from 2 mm to 30 mm (average 7.4 mm). Of the 67 patients, 52 (78 %) displayed the characteristic endoscopic findings of smooth, round, sessile elevations covered with normal-appearing or yellow-discolored mucosa; in 15 (22 %) there were one or more atypical endoscopic findings. These included a semipedunculated appearance (n = 6), hyperemia (n = 5), a central depression (n = 6), erosion (n = 5), and ulceration (n = 4). Atypical findings were noted in none of 20 carcinoids &lambda< 5 mm in diameter; in six (20 %) of the 30 carcinoids between 5 mm and 9 mm; in six (43 %) of the 14 carcinoids between 10 mm and 19 mm; and in three (100 %) of the three carcinoids >/= 20 mm in diameter ( P < 0.001). Invasion into the muscularis propria or metastasis to the liver or lymph nodes occurred in three of the four patients with ulceration, but it was confirmed in only one of the 63 patients without ulceration ( P < 0.001). CONCLUSIONS: Atypical endoscopic appearances of rectal carcinoids are observed more frequently as the size of the tumor increases and a finding of ulceration may have a prognostic value.     

胃肠道类癌的诊治和预后分析

目的探讨胃肠道类癌的诊断治疗和预后影响因素。方法对1998年12月至2007年12月间收治的40例胃肠道类癌患者的临床资料进行回顾性分析。结果40例患者男女比例1.86∶1,平均年龄59.3岁。主要临床表现为腹部疼痛、消化道出血和腹泻。病灶中位大小4 cm,肿瘤直径≤2 cm者5年生存率88%,直径>2 cm者5年生存率为32%(P=0.0038)。T1-2、T3和T4期患者的5年生存率具有明显差异(P<0.01),分别为82%、44%和17%。不伴有淋巴结转移者和伴有淋巴结转移者的5年生存率分别为80%和31%(P=0.0017),总5年生存率52%。结论手术是胃肠道类癌的主要治疗手段,预后和肿瘤大小、浸润深度以及淋巴结转移相关。     

31例直径1~2 cm直肠类癌的手术治疗

  目的  探讨直径1~2 cm直肠类癌的临床特点及手术方式选择。  方法  回顾性分析北京协和医院2000年1月至2012年12月收治的31例直径在1~2 cm之间的直肠类癌患者的临床资料。其中男17例, 女14例; 年龄24~77岁, 中位年龄46岁。  结果  31例患者中, 临床表现为腹部不适、排便次数增多18例(58.1%), 便血2例(6.5%); 余11例患者无症状。本组患者行局部切除术26例, 包括经肛门内镜微创手术19例(61.3%), 经肛门括约肌途径直肠肿物切除术(Mason术)4例(12.9%), 经肛门肿物切除术3例(9.7%); 行根治性切除手术5例(16.1%)。术后病理回报所有病例均为直肠类癌, 病变局限于黏膜下层25例; 浸润肌层6例, 其中淋巴结转移1例。29例患者得到随访, 病变局限于黏膜下层者(n=23)5年生存率为95.7%, 浸润肌层者(n=6)5年生存率为50%(P < 0.001)。  结论  直径1~2 cm直肠类癌, 病变局限于黏膜下层者可行局部切除, 病变侵及肌层者行根治性切除为妥。     

Effectiveness of endoscopic treatment of carcinoid tumors of the rectum

The effectiveness of endoscopic polypectomy in the treatment of carcinoid tumors of the rectum was investigated. Flat tumors of less than 1.5 cm in the largest diameter, of normal or yellow color, consisting histologically of solid nodular nests or trabecular or ribbon-like structures were "early" tumors, in which the tumor cells were confined to the mucosa and submucosa, and did not involve deeper layers. Eight patients with "early" carcinoids were treated by endoscopic polypectomy. Subsequently, two of them were submitted to surgery, while the other six were followed-up endoscopically. Histological examination of the specimens obtained at operation showed no evidence of residual tumor cells at the polypectomy site. Endoscopic follow-up studies also failed to reveal local recurrence in any of the patients during the average observation period of 1.3 years. The wall of the rectum was significantly thicker than that of the sigmoid colon, so that deeper local excision was possible. These findings indicate that even though "early" carcinoid tumors of the rectum showed submucosal invasion, they were completely cured by local endoscopic excision.     

青少年阑尾类癌10例临床病理分析

目的探讨青少年阑尾类癌的临床病理特点。方法回顾性分析10例青少年阑尾类癌的临床病理资料及HE切片，并进行嗜铬颗粒蛋白A（CgA）、神经元特异性烯醇化酶（NSE）、突触素（Syn）免疫组化标记辅助诊断。结果肿块位于阑尾末端8例，根部2例。肿块直径〈2cm者8例，均行阑尾切除术；直径〉2cm者2例，1例行盲肠切除术，1例行右侧结肠切除术。光镜下癌细胞大小、形状、染色较一致，排列呈巢状、腺泡状。10例CgA、NSE均为（＋），7例Syn为（＋）。10例均经随访未见复发和转移。结论阑尾类癌为低度恶性的APUD源性肿瘤，预后较好。青少年患者手术治疗后可不需化疗、放疗。     

Reevaluation of the term "carcinoid"--how to deal with this misnomer

In the present review, the malignant entity of so-called carcinoid is discussed from three points of view: [I] The earliest extraglandular(intramucosal) invasion of neoplastic cells following a focal penetration of the basement membrane of a gastric gland in the form of a "budding phenomenon", confirmed on multiple consecutive serial sections. [II] Reevaluation of the original diagram of the submucosal tumor, that is a result of invasion from the original site in the mucosa. [III] Analysis of human materials on metastasis rates at the stage of submucosal-nodule formation in the stomach and rectum. It is confirmed that carcinoid is a malignant epithelial neoplasm at its origin, and that the term carcinoid is a misnomer. Recognizing such an entity, it is emphasized that this nomenclature should be preserved for a future research activities, while the other nomenclature more adequate and generally acceptable for this neoplasm should be world-widely sought. The author's proposal is that the two terms are best expressed using parentheses; e.g. endocrinocarcinoma (carcinoid) or vice versa.     

31例直径1～2cm直肠类癌的手术治疗

目的 探讨直径1～2cm直肠类癌的临床特点及手术方式选择。方法对我院2000年1月至2012年12月收治的31例直径在1～2cm之间的直肠类癌病例的临床资料进行回顾性分析。结果本组男17例,女14例;年龄24～77岁,中位年龄46岁。临床表现为腹部不适、排便次数增多18例（58.1%）,便血2例（6.45%）;余11例患者无症状。本组患者行局部切除术26例,包括经肛门内镜微创手术（TEM）19例（61.2%）,经肛门括约肌途径直肠肿物切除术（Mason术）4例（12.9%）,经肛门肿物切除术3例（9.7%）;行根治性切除手术5例（16.1%）。术后病理回报所有病例均为直肠类癌,病变局限于粘膜下层25例;浸润肌层6例,其中淋巴结转移1例。29例患者得到随访,病变局限于粘膜下层组（n=23）五年生存率为95.7%,浸润肌层组（n=6）五年生存率为50%（P<0.001）。结论直径1～2cm直肠类癌患者中,病变局限于粘膜下层者可行局部切除,病变侵及肌层者行根治性切除为妥。