胃肠道类癌13例临床分析
摘要
目的:探讨胃肠道类癌的临床表现、诊断方法、治疗方法及误诊病例分析,以提高对胃肠道类癌的认识及诊治。
方法:回顾分析我院自2004.1-2008.10月收治的具有完整病例的13例胃肠道类癌的临床资料。
结果:13例类癌中,平均年龄43.3岁,病程6月-10年余不等,平均病程18.7月余。直肠类癌7例(53.8%),阑尾类癌3例(23.1%),食管类癌1例(7.7%),胃类癌1例(7.7%),十二指肠乳头类癌1例(7.7%)。临床症状中腹痛多见,占61.5%,其次为大便习惯改变,占53.8%,恶心呕吐占23.1%,消化道出血占15.4%。4例行CT检查,2例发现病灶或转移灶,2例发现有异常。10例行内镜检查,10例发现病变。6例经内镜下活检病理明确,7例经手术后病理明确。确诊前各有1例误诊为腺癌,粘膜下肿瘤,小细胞癌,黏膜慢性炎症。3例阑尾类癌均误诊为阑尾炎。12例经外科手术治疗,其中1例阑尾类癌伴淋巴结转移者术后氟尿嘧啶化疗1次。直肠类癌1例伴肝脏转移者行内镜下摘除直肠类癌后姑息化疗4次。
结论:胃肠道类癌无特异性临床表现,腹痛、大便习惯改变多见,诊断较为困难,病理活检是重要的检查方法,但仍需结合CT等检查。胃肠道类癌以手术为主要治疗方式,必要时需联合多种治疗方法,部分类癌可行内镜下治疗。
Objective:To discuss the clinical manifestation,diagnostic methods,the therapy of gastrointestinal tract carcinoid tumors and analyse cases which were misdiagnosed,in order to improve the level of recognition and diagnosis.
Methods:The data of 13 cases of gastrointestinal tract carcinoid tumors which were hospitalized during Jan,2004 and Oct,2008 were analysed retrospectively.
Results:In our results,the average age of patients was 43.3.The internal from onset to be diagnosed was from 6 months to 10 years,with 18.7 months as average.The rectum is the most common site of carcinoids(53.8%),followed by the appendix (23.1%),then the esophagus,stomach and duodenal papilla is 7.7%respectively.The most common symptoms were abdominal pain(61.5%);changing of the habits of defecation(53.8%),nausea and vomiting(23.1%),bleeding of gastrointestinal tract (15.4%).CT was performed,in 4 cases,primory or metastasis was detected in 2 cases, and 2 were abnormal.Endoscopy was performed in 10 cases,positive findings were detected in 10 cases.6 cases got final diagnosis per endoscopy and biopsy,7 patients by operation and biopsy.Before final diagnosis,there was 1 case misdiagnosed for adeno-carcinoma,submucous tumor,small cell carcinoma and chronic inflammation of mucous membrane respectively,the carcinoids of appendix were all misdiagnosed for appendicitis.12 patients were taken a surgical resection,the rectum with hepatic metastases perfered four times of palliative systemic chemotherapeutic after endoscopic resection of primary carcinoids,another appendix carcinoid with lymph node involvement applied 5-fluorouracil after appendectomy.
Conclusions:The clinical manifestations of gastrointestinal tract carcinoid tumors were non-specific.Abdominal pain and changing of the habits of defecation are the most commen symptoms.These neoplasms pose a diagnostic challenge.Biopsy is an imporment method to diagnose,but need to combined with CT and so on.Operation is the main approach to cure,and may need symphysial managements necessary,some of the carcinoids maybe cured by endoscope.
方法:回顾分析我院自2004.1-2008.10月收治的具有完整病例的13例胃肠道类癌的临床资料。
结果:13例类癌中,平均年龄43.3岁,病程6月-10年余不等,平均病程18.7月余。直肠类癌7例(53.8%),阑尾类癌3例(23.1%),食管类癌1例(7.7%),胃类癌1例(7.7%),十二指肠乳头类癌1例(7.7%)。临床症状中腹痛多见,占61.5%,其次为大便习惯改变,占53.8%,恶心呕吐占23.1%,消化道出血占15.4%。4例行CT检查,2例发现病灶或转移灶,2例发现有异常。10例行内镜检查,10例发现病变。6例经内镜下活检病理明确,7例经手术后病理明确。确诊前各有1例误诊为腺癌,粘膜下肿瘤,小细胞癌,黏膜慢性炎症。3例阑尾类癌均误诊为阑尾炎。12例经外科手术治疗,其中1例阑尾类癌伴淋巴结转移者术后氟尿嘧啶化疗1次。直肠类癌1例伴肝脏转移者行内镜下摘除直肠类癌后姑息化疗4次。
结论:胃肠道类癌无特异性临床表现,腹痛、大便习惯改变多见,诊断较为困难,病理活检是重要的检查方法,但仍需结合CT等检查。胃肠道类癌以手术为主要治疗方式,必要时需联合多种治疗方法,部分类癌可行内镜下治疗。
Objective:To discuss the clinical manifestation,diagnostic methods,the therapy of gastrointestinal tract carcinoid tumors and analyse cases which were misdiagnosed,in order to improve the level of recognition and diagnosis.
Methods:The data of 13 cases of gastrointestinal tract carcinoid tumors which were hospitalized during Jan,2004 and Oct,2008 were analysed retrospectively.
Results:In our results,the average age of patients was 43.3.The internal from onset to be diagnosed was from 6 months to 10 years,with 18.7 months as average.The rectum is the most common site of carcinoids(53.8%),followed by the appendix (23.1%),then the esophagus,stomach and duodenal papilla is 7.7%respectively.The most common symptoms were abdominal pain(61.5%);changing of the habits of defecation(53.8%),nausea and vomiting(23.1%),bleeding of gastrointestinal tract (15.4%).CT was performed,in 4 cases,primory or metastasis was detected in 2 cases, and 2 were abnormal.Endoscopy was performed in 10 cases,positive findings were detected in 10 cases.6 cases got final diagnosis per endoscopy and biopsy,7 patients by operation and biopsy.Before final diagnosis,there was 1 case misdiagnosed for adeno-carcinoma,submucous tumor,small cell carcinoma and chronic inflammation of mucous membrane respectively,the carcinoids of appendix were all misdiagnosed for appendicitis.12 patients were taken a surgical resection,the rectum with hepatic metastases perfered four times of palliative systemic chemotherapeutic after endoscopic resection of primary carcinoids,another appendix carcinoid with lymph node involvement applied 5-fluorouracil after appendectomy.
Conclusions:The clinical manifestations of gastrointestinal tract carcinoid tumors were non-specific.Abdominal pain and changing of the habits of defecation are the most commen symptoms.These neoplasms pose a diagnostic challenge.Biopsy is an imporment method to diagnose,but need to combined with CT and so on.Operation is the main approach to cure,and may need symphysial managements necessary,some of the carcinoids maybe cured by endoscope.
引文
[1]Scott N.Pinchot,Kyle Holen et al.Carcinoid Tumors.The Oncologist,2008,13(12):1255-1269.
[2]Modlin IM,Lye KD,Kidd M.A 5-decade analysis of 13715 carcinoid tumor.Cancer,2003,97(4):934-959.
[3]Schnirer Ⅱ,Yao JC,Ajani JA.Carcinoid— a comprehensive review.Acta Oncologica,2003,42(7):672-92;
[4]Matthew H.Kulke.Neuroendocrine tumours:clinical presentation and management of localized disease.Cancer theatment reviews.2003,29(5):363-370.
[5]Mazhar U.Khan,R.Edward Coleman.Diagnosis and therapy of carcinoid tumors-current state of the art and future directions.Nuclear Medicine and Biology 2008,35,Supplement 1:S77-S91.
[6]Sara Massironi,Valentina Sciola et al.Neuroendocrine tumors of the gastroentero -pancreatic system.World J Gastroenterol.2008,14(35):5377-5384.
[7]陈灏珠等主编,实用内科学(下册).第12版.北京:人民卫生出版社,2005:1926-1930
[8]王志成,郭德玉等.食管类癌三例.中华消化外科杂志,2007,6(6):435,444。
[9]Irvin M.Modlin,Kevin D.Lye,Mark Kidda.Carcinoid tumors of the stomach.Surgical Oncology,2003.12(2):.153-172.
[10]白影利,彭英政.十二指肠类癌及类癌综合征(附5例报告)。中国医师进修杂志,2007,30(6):58-59.
[11]Gilani N,Ramirez FC.Endoscopic resection of an ampullary carcinoid presenting with upper gastrointestinal bleeding:A case report and review of the literature.World Journal of Gastroenterology,2007,13(8):1268-1270.
[12]贾忠,贺冠海等。阑尾类癌九例临床分析.中华胃肠外科杂志,2006,9(1): 74-75.
[13]尤俊,许林等。胃肠道类癌4 9例临床分析.中华胃肠外科杂志,2005,8(5):460-461.
[14]张斌,李长锋等.经内镜诊治直肠类癌.中华消化内镜,2008,2(7):5-8。
[15]Kwaan MR,Goldberg JE et al.Rectal carcinoid tumors:review of results after endoscopic and surgical therapy.Arch Surg,2008,143(5):471-475.
[1]Modlin EVI,Lye KD,Kidd M.A 5-decade analysis of 13715 carcinoid tumor.Cancer,2003,97 (4):934-959.
[2]Matthew H.Kulke et al.Neuroendocrine tumours:clinical presentation and management of localized disease.Cancer theatment reviews,2003,29 (5):363-370.
[3]Ganim RB,Norton JA,et al.Recent advances in carcinoid pathogenesis,diagnosis and management.Surgical Oncology,2000,9 (4):173-9.
[4]Modlin EVI,Sandor A.An analysis of 8305 cases of carcinoid tumors.Cancer,1997,79:813-29.
[5]Schnirer Ⅱ,Yao JC,et al.Carcinoid—a comprehensive review.Acta Oncologica,2003,42 (7):672-92;
[6]Mazhar U.Khan,R.Edward Coleman.Diagnosis and therapy of carcinoid tumors—current state of the art and future directions.Nuclear Medicine and Biology,2008,35,Supplement 1:S77-S91.
[7]Scott N.Pinchot,Kyle Holen et al.Carcinoid Tumors.The Oncologist,2008,13 (12):1255-1269.
[8]Chang JH;Kim SW et al.Clinical review of gastrointestinal carcinoid tumor and analysis of the factors predicting metastasis.The Korean Journal Of Gastroenterology.2007.50(1):19-25.
[9]R Gore,J Berlin et al.GI carcinoid tumours:appearance of the primary and detecting metastases.Best Practice & Research Clinical Endocrinology & Metabolism,2005,19(2):245-263.
[10]Sara Massironi,Valentina Sciola et al.Neuroendocrine tumors of the gastro-entero-pancreatic system. World Journal of Gastroenterology,2008,14(35):5377-5384.
[11]陈灏珠等主编,实用内科学(下册).第12版.北京:人民卫生出版社,2005:1926-1930.
[12]王志成,郭德玉等.食管类癌三例.中华消化外科杂志,2007,6(6):435,444。
[13]Irvin M.Modlin,Kevin D.Lye,et al.Carcinoid tumors of the stomach.Surgical Oncology,2003.12(2):153-172.
[14]白影利,彭英政.十二指肠类癌及类癌综合征(附5例报告).中国医师进修杂志,2007,30(6):58-59.
[15]Hartel M,Wente MN,et al.Carcinoid of the ampulla of Vater.J Gastroenterol Hepatol,2005,20(5):676-681.
[16]Gilani N,Ramirez FC.Endoscopic resection of an ampullary carcinoid presenting with upper gastrointestinal bleeding:A case report and review of the literature.World Journal of Gastroenterology,2007,13(8):1268-1270.
[17]尤俊,许林,张志明等.胃肠道类癌49例临床分析.中华胃肠外科杂志,2005,8(5):460-461.
[18]Schwartz G,Colanta A et al.Primary carcinoid tumors of the liver.World J Surg Oncol,2008,6:91
[19]David S.Foley,Indira Sunil,et al.Primary hepatic carcinoid tumor in children.Journal of Pediatric Surgery,2008,43(11):E25-E28
[20]Zhang A,Xiang Jet al.Primary hepatic carcinoid tumours:clinical features with an emphasis on carcinoid syndrome and recurrence.J Int Med Res.2008,36(4):848-59.
[21]许海莺,陈宏颖等.胰腺类癌1例报告并文献复习。中国误诊学杂志,2007,7,(6):1186-1188.
[22]Soga J.Carcinoids of the panceres:an analysis of 156 cases.Cancer,2005,104(6):1180-1187.
[23]J.Bendelow,E.Apps,et al.Carcinoid syndrome.European Journal of Surgical Oncology.2008,34(3):289-296.
[24]Sippel RS,Chen H.Carcinoid tumors.Surg Oncol Clin N Am.2006,15:463478.
[25]Taal BG,Hoefnagel CA et al.Combined diagnostic imaging with 131I- Metaiodobenzylguanidine and 111In-pentetreotide in carcinoid tumours.European European Journal Of Cancer.,1996;32A(11):1924-1932.
[26]胡祥鹏,吴明等。上消化道类癌的内镜诊断及病理分析。中国内镜杂志,2008,14(3):306-309.
[27]张斌 李长锋等。经内镜诊治直肠类癌。中华消化内镜,2008,2(7):5-8。
[28]周平红,姚礼庆等。直肠类癌的内镜超声诊断和内镜黏膜下切除.中华消化内镜杂志2006,23(3):175-178。
[29]Stridsberg M,Oberg K,et al..Measurements of chromogranin A,chromogranin B (secretograninⅠ),chromogranin C(secretogranin Ⅱ) and pancreastatinin plasma and urine from patients with carcinoid tumours and endocrine pancreatic tumours.J Endocrinol,1995,144:49-59.
[30]林秀英,张啸等。十二指肠乳头类癌一例及文献复习。中华消化内镜杂志,2007,24(2):147-149。
[31]Kim YJ,Lee SK et al.Efficacy of endoscopic resection for small rectal carcinoid:a retrospective study.Korean J Gastroenterol,2008,51(3):174-80.
[32]Landry CS,Scoggins CR,et al:Management of hepatic metastasis of gastrointestinal carcinoid tumors.Journal of Surgical Oncology,2008,97(3):253-258.
[1]Modlin IM,Lye KD,et al.A 5-decade analysis of 13715 carcinoid tumor.Cancer,2003,97(4):934-959.
[2]Schnirer Ⅱ,Yao JC,et al.Carcinoid—a comprehensive review.Acta Oncologica,2003,42(7):672-92;
[3]Hartel M,Wente MN,et al.Carcinoid of the ampulla of Vater.Journal Gastroenterol Hepatol,2005,20(5):676-681.
[4]Toth Fejel S,Pommier RF.Relationships among delay of diagnosis,extent of disease and survival in patients with abdominal carcinoid tumors.Am J surg,2004,187(5):575-579,
[5]Pyun DK,Moon G,Han J,et al.A carcinoid tumor of the ampulla of Vater treated by endoscopic snare papillecto.Korean J Intern Med,2004,19:257-260.
[6]林秀英,张啸,项晶晶.十二指肠乳头类癌一例及文献复习.中华消化内镜杂志,2007,24(2):147-149.
[7]Gilani N,Ramirez FC.ndoscopic resection of an ampullary carcinoid presenting with upper gastrointestinal bleeding:A case report and review of the literature.World Journal of Gastroenterology.2007,13(8):1268-1270.
[8]Modlin IM,Salldol A.An analysis of 8305 case of carcinoid tumors.Cancer,1997,79(40):813-829.
[2]Modlin IM,Lye KD,Kidd M.A 5-decade analysis of 13715 carcinoid tumor.Cancer,2003,97(4):934-959.
[3]Schnirer Ⅱ,Yao JC,Ajani JA.Carcinoid— a comprehensive review.Acta Oncologica,2003,42(7):672-92;
[4]Matthew H.Kulke.Neuroendocrine tumours:clinical presentation and management of localized disease.Cancer theatment reviews.2003,29(5):363-370.
[5]Mazhar U.Khan,R.Edward Coleman.Diagnosis and therapy of carcinoid tumors-current state of the art and future directions.Nuclear Medicine and Biology 2008,35,Supplement 1:S77-S91.
[6]Sara Massironi,Valentina Sciola et al.Neuroendocrine tumors of the gastroentero -pancreatic system.World J Gastroenterol.2008,14(35):5377-5384.
[7]陈灏珠等主编,实用内科学(下册).第12版.北京:人民卫生出版社,2005:1926-1930
[8]王志成,郭德玉等.食管类癌三例.中华消化外科杂志,2007,6(6):435,444。
[9]Irvin M.Modlin,Kevin D.Lye,Mark Kidda.Carcinoid tumors of the stomach.Surgical Oncology,2003.12(2):.153-172.
[10]白影利,彭英政.十二指肠类癌及类癌综合征(附5例报告)。中国医师进修杂志,2007,30(6):58-59.
[11]Gilani N,Ramirez FC.Endoscopic resection of an ampullary carcinoid presenting with upper gastrointestinal bleeding:A case report and review of the literature.World Journal of Gastroenterology,2007,13(8):1268-1270.
[12]贾忠,贺冠海等。阑尾类癌九例临床分析.中华胃肠外科杂志,2006,9(1): 74-75.
[13]尤俊,许林等。胃肠道类癌4 9例临床分析.中华胃肠外科杂志,2005,8(5):460-461.
[14]张斌,李长锋等.经内镜诊治直肠类癌.中华消化内镜,2008,2(7):5-8。
[15]Kwaan MR,Goldberg JE et al.Rectal carcinoid tumors:review of results after endoscopic and surgical therapy.Arch Surg,2008,143(5):471-475.
[1]Modlin EVI,Lye KD,Kidd M.A 5-decade analysis of 13715 carcinoid tumor.Cancer,2003,97 (4):934-959.
[2]Matthew H.Kulke et al.Neuroendocrine tumours:clinical presentation and management of localized disease.Cancer theatment reviews,2003,29 (5):363-370.
[3]Ganim RB,Norton JA,et al.Recent advances in carcinoid pathogenesis,diagnosis and management.Surgical Oncology,2000,9 (4):173-9.
[4]Modlin EVI,Sandor A.An analysis of 8305 cases of carcinoid tumors.Cancer,1997,79:813-29.
[5]Schnirer Ⅱ,Yao JC,et al.Carcinoid—a comprehensive review.Acta Oncologica,2003,42 (7):672-92;
[6]Mazhar U.Khan,R.Edward Coleman.Diagnosis and therapy of carcinoid tumors—current state of the art and future directions.Nuclear Medicine and Biology,2008,35,Supplement 1:S77-S91.
[7]Scott N.Pinchot,Kyle Holen et al.Carcinoid Tumors.The Oncologist,2008,13 (12):1255-1269.
[8]Chang JH;Kim SW et al.Clinical review of gastrointestinal carcinoid tumor and analysis of the factors predicting metastasis.The Korean Journal Of Gastroenterology.2007.50(1):19-25.
[9]R Gore,J Berlin et al.GI carcinoid tumours:appearance of the primary and detecting metastases.Best Practice & Research Clinical Endocrinology & Metabolism,2005,19(2):245-263.
[10]Sara Massironi,Valentina Sciola et al.Neuroendocrine tumors of the gastro-entero-pancreatic system. World Journal of Gastroenterology,2008,14(35):5377-5384.
[11]陈灏珠等主编,实用内科学(下册).第12版.北京:人民卫生出版社,2005:1926-1930.
[12]王志成,郭德玉等.食管类癌三例.中华消化外科杂志,2007,6(6):435,444。
[13]Irvin M.Modlin,Kevin D.Lye,et al.Carcinoid tumors of the stomach.Surgical Oncology,2003.12(2):153-172.
[14]白影利,彭英政.十二指肠类癌及类癌综合征(附5例报告).中国医师进修杂志,2007,30(6):58-59.
[15]Hartel M,Wente MN,et al.Carcinoid of the ampulla of Vater.J Gastroenterol Hepatol,2005,20(5):676-681.
[16]Gilani N,Ramirez FC.Endoscopic resection of an ampullary carcinoid presenting with upper gastrointestinal bleeding:A case report and review of the literature.World Journal of Gastroenterology,2007,13(8):1268-1270.
[17]尤俊,许林,张志明等.胃肠道类癌49例临床分析.中华胃肠外科杂志,2005,8(5):460-461.
[18]Schwartz G,Colanta A et al.Primary carcinoid tumors of the liver.World J Surg Oncol,2008,6:91
[19]David S.Foley,Indira Sunil,et al.Primary hepatic carcinoid tumor in children.Journal of Pediatric Surgery,2008,43(11):E25-E28
[20]Zhang A,Xiang Jet al.Primary hepatic carcinoid tumours:clinical features with an emphasis on carcinoid syndrome and recurrence.J Int Med Res.2008,36(4):848-59.
[21]许海莺,陈宏颖等.胰腺类癌1例报告并文献复习。中国误诊学杂志,2007,7,(6):1186-1188.
[22]Soga J.Carcinoids of the panceres:an analysis of 156 cases.Cancer,2005,104(6):1180-1187.
[23]J.Bendelow,E.Apps,et al.Carcinoid syndrome.European Journal of Surgical Oncology.2008,34(3):289-296.
[24]Sippel RS,Chen H.Carcinoid tumors.Surg Oncol Clin N Am.2006,15:463478.
[25]Taal BG,Hoefnagel CA et al.Combined diagnostic imaging with 131I- Metaiodobenzylguanidine and 111In-pentetreotide in carcinoid tumours.European European Journal Of Cancer.,1996;32A(11):1924-1932.
[26]胡祥鹏,吴明等。上消化道类癌的内镜诊断及病理分析。中国内镜杂志,2008,14(3):306-309.
[27]张斌 李长锋等。经内镜诊治直肠类癌。中华消化内镜,2008,2(7):5-8。
[28]周平红,姚礼庆等。直肠类癌的内镜超声诊断和内镜黏膜下切除.中华消化内镜杂志2006,23(3):175-178。
[29]Stridsberg M,Oberg K,et al..Measurements of chromogranin A,chromogranin B (secretograninⅠ),chromogranin C(secretogranin Ⅱ) and pancreastatinin plasma and urine from patients with carcinoid tumours and endocrine pancreatic tumours.J Endocrinol,1995,144:49-59.
[30]林秀英,张啸等。十二指肠乳头类癌一例及文献复习。中华消化内镜杂志,2007,24(2):147-149。
[31]Kim YJ,Lee SK et al.Efficacy of endoscopic resection for small rectal carcinoid:a retrospective study.Korean J Gastroenterol,2008,51(3):174-80.
[32]Landry CS,Scoggins CR,et al:Management of hepatic metastasis of gastrointestinal carcinoid tumors.Journal of Surgical Oncology,2008,97(3):253-258.
[1]Modlin IM,Lye KD,et al.A 5-decade analysis of 13715 carcinoid tumor.Cancer,2003,97(4):934-959.
[2]Schnirer Ⅱ,Yao JC,et al.Carcinoid—a comprehensive review.Acta Oncologica,2003,42(7):672-92;
[3]Hartel M,Wente MN,et al.Carcinoid of the ampulla of Vater.Journal Gastroenterol Hepatol,2005,20(5):676-681.
[4]Toth Fejel S,Pommier RF.Relationships among delay of diagnosis,extent of disease and survival in patients with abdominal carcinoid tumors.Am J surg,2004,187(5):575-579,
[5]Pyun DK,Moon G,Han J,et al.A carcinoid tumor of the ampulla of Vater treated by endoscopic snare papillecto.Korean J Intern Med,2004,19:257-260.
[6]林秀英,张啸,项晶晶.十二指肠乳头类癌一例及文献复习.中华消化内镜杂志,2007,24(2):147-149.
[7]Gilani N,Ramirez FC.ndoscopic resection of an ampullary carcinoid presenting with upper gastrointestinal bleeding:A case report and review of the literature.World Journal of Gastroenterology.2007,13(8):1268-1270.
[8]Modlin IM,Salldol A.An analysis of 8305 case of carcinoid tumors.Cancer,1997,79(40):813-829.