本文關(guān)鍵詞： 支氣管肺類癌 異位ACTH綜合征 診斷 手術(shù)治療 預后　出處：《北京協(xié)和醫(yī)學院》2017年碩士論文　論文類型：學位論文

【摘要】：目的探討支氣管肺類癌致異位促腎上腺皮質(zhì)激素(Adrenocorticotropic Hormone,ACTH)綜合征的疾病特點、診治方法及預后情況。方法選取2007年3月至2016年5月間經(jīng)北京協(xié)和醫(yī)院診治并由手術(shù)病理證實的支氣管肺類癌引起的異位ACTH綜合征20例,其中男性13例,女性7例。搜集并整理20例患者的重要臨床數(shù)據(jù),并進行統(tǒng)計分析。結(jié)果20例患者就診時的平均年齡為38.85± 15.31歲(13～70歲),中位病程15個月(范圍:1～156個月)。所有患者均存在庫欣綜合征的典型臨床表現(xiàn),均由胸部CT定位胸部病變。手術(shù)治療后血清皮質(zhì)醇及血ACTH濃度均明顯下降。術(shù)后并發(fā)癥3例(15%),均為嚴重肺部感染。隨訪18例患者,中位隨訪時間31.5月(范圍:12月～122月),其中典型類癌13例、不典型類癌5例,Ⅰa期7例、Ⅰb期1例、Ⅱa期2例、Ⅲa期8例,1例行術(shù)后放療、3例行術(shù)后化療。隨訪時間內(nèi),1例復發(fā)轉(zhuǎn)移,無死亡病例。典型類癌與不典型類癌的Ki67、術(shù)后血F、腫瘤大小,吸煙與否的腫瘤大小,及淋巴結(jié)轉(zhuǎn)移與否的病程,差別有統(tǒng)計學意義。術(shù)前血ACTH與年齡存在正相關(guān),與血鉀存在負相關(guān)。結(jié)論1.支氣管肺類癌所致異位ACTH綜合征是一種極為罕見的疾病,早期診斷及治療對臨床醫(yī)師存在很大難度,需要多種的檢查手段及多專科醫(yī)師共同診治;2.胸部CT是發(fā)現(xiàn)病變并評估手術(shù)可行性的重要方法;3.早期手術(shù)切除異位分泌ACTH腫瘤是治療該病的有效手段,且大多可獲長期生存;4.不常規(guī)推薦對病變完全切除的PTC或PAC患者進行輔助治療,無論其是否有區(qū)域淋巴結(jié)轉(zhuǎn)移;5.病理分型及分期可能是影響預后的因素,但需要積累更多的數(shù)據(jù)證實;6.高齡女性可能更容易發(fā)生嚴重低血鉀,而術(shù)后血F可能是與預后相關(guān)的預測因子。
[Abstract]:Objective to investigate the characteristics of Adrenocorticotropic Hormoneic ACTH syndrome induced by bronchial lung carcinoid. Methods from March 2007 to May 2016, 20 cases of heterotopic ACTH syndrome caused by bronchopulmonary carcinoid proved by operation and pathology were selected. Among them, 13 cases were males and 7 cases were females. The important clinical data of 20 patients were collected and sorted out. Results the mean age of 20 patients was 38.85 鹵15.31 years old or 1370 years old. The median course of disease was 15 months (range: 1 ~ 156 months). All patients had typical clinical manifestations of Cushing's syndrome. All chest lesions were located by chest CT. The serum cortisol and serum ACTH levels were significantly decreased after operation. Postoperative complications were found in 3 cases with severe pulmonary infection. 18 patients were followed up. The median follow-up time was 31.5 months (range: December to 122 months), including 13 cases of typical carcinoid, 5 cases of atypical carcinoid, 7 cases of stage 鈪，

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