本文關(guān)鍵詞： 膽囊 神經(jīng)內(nèi)分泌癌 根治性手術(shù) 放療 化療　出處：《山東大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：背景:膽囊神經(jīng)內(nèi)分泌癌(GB-NECs)在臨床上較為少見(jiàn),患者通常無(wú)特異性癥狀及體征,可表現(xiàn)為腹痛、黃疸、類(lèi)癌綜合征、腹水、體重迅速下降等。膽囊神經(jīng)內(nèi)分泌癌的病因及發(fā)病機(jī)制至今尚不明確,可能與干細(xì)胞分化、膽囊粘膜細(xì)胞化生有關(guān)。本文對(duì)作者所在醫(yī)院收治的6例膽囊神經(jīng)內(nèi)分泌癌病例進(jìn)行報(bào)道,并對(duì)國(guó)內(nèi)外相關(guān)文獻(xiàn)進(jìn)行復(fù)習(xí),探討膽囊神經(jīng)內(nèi)分泌癌患者的診斷與治療。目的:分析6例膽囊神經(jīng)內(nèi)分泌癌患者的病情進(jìn)展及診療經(jīng)過(guò),復(fù)習(xí)國(guó)內(nèi)近年來(lái)關(guān)于膽囊神經(jīng)內(nèi)分泌癌的報(bào)道文獻(xiàn),為膽囊神經(jīng)內(nèi)分泌癌的臨床診治提供依據(jù)。方法:回顧性分析山東大學(xué)齊魯醫(yī)院收治的6例膽囊神經(jīng)內(nèi)分泌癌患者的病史、臨床資料、實(shí)驗(yàn)室檢查、影像學(xué)檢查、手術(shù)治療及輔助治療方案;以"膽囊神經(jīng)內(nèi)分泌腫瘤"、"膽囊神經(jīng)內(nèi)分泌癌"、"膽囊類(lèi)癌"等為檢索詞,檢索CNKI(相關(guān)期刊論文)、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)(CBM)、萬(wàn)方文獻(xiàn)數(shù)據(jù)庫(kù),檢索1998年以來(lái)國(guó)內(nèi)發(fā)表的膽囊神經(jīng)內(nèi)分泌癌病例報(bào)道文獻(xiàn),選擇性地選取相關(guān)文獻(xiàn)并閱讀其摘要或全文;加上作者所在醫(yī)院收治的6例,總共收集42例GB-NECs病例,分析患者的臨床資料并結(jié)合國(guó)內(nèi)相關(guān)文獻(xiàn)分析歸納膽囊神經(jīng)內(nèi)分泌癌臨床診斷治療的要點(diǎn)及研究進(jìn)展。結(jié)果:42例患者中,男性16例,女性26例,男女比例為1:1.625。發(fā)病年齡25-80歲,平均57.7歲。42例中共有40例報(bào)道了患者的臨床表現(xiàn),以腹痛、腹脹最為常見(jiàn)(72.5%),其他癥狀還有黃疸、納差、惡心嘔吐、腹部包塊等,僅2例合并類(lèi)癌綜合征�；颊叩膶�(shí)驗(yàn)室檢查結(jié)果中癌胚抗原、糖類(lèi)抗原、甲胎蛋白等腫瘤標(biāo)記物無(wú)特異性,患者接受的輔助檢查主要有超聲、CT、MR,與膽囊癌等鑒別困難,最終確診需要依靠病理組織檢查聯(lián)合免疫組化。免疫組化最重要的特征是突觸素(Syn)、嗜鉻粒蛋白A(CgA)陽(yáng)性。膽囊神經(jīng)內(nèi)分泌癌最有效的治療是腫瘤根治性切除術(shù),手術(shù)聯(lián)合化療在一定程度上可以改善患者預(yù)后。42例患者中隨訪24例,存活時(shí)間為55天—3年10個(gè)月。結(jié)論:1.膽囊神經(jīng)內(nèi)分泌癌罕見(jiàn),發(fā)現(xiàn)時(shí)往往已浸潤(rùn)周?chē)M織及發(fā)生淋巴結(jié)轉(zhuǎn)移;2.GB-NECs的臨床表現(xiàn)、影像學(xué)檢查無(wú)特異性,實(shí)驗(yàn)室檢查亦無(wú)明顯特異性的腫瘤學(xué)指標(biāo),早期診斷困難,主要依靠術(shù)后病理學(xué)檢查尤其是免疫組化檢查確診;3.外科手術(shù)治療仍是最有效的治療手段,化療聯(lián)合手術(shù)治療膽囊神經(jīng)內(nèi)分泌癌取得了肯定的療效;4.采取綜合治療可以延長(zhǎng)膽囊神經(jīng)內(nèi)分泌癌患者的生存期,改善預(yù)后,但目前膽囊神經(jīng)內(nèi)分泌癌患者的整體預(yù)后仍較差。
[Abstract]:Background: GB-NECsof gallbladder neuroendocrine carcinoma is rare in clinic. Patients usually have no specific symptoms and signs, and can present with abdominal pain, jaundice, carcinoid syndrome, ascites. The etiology and pathogenesis of neuroendocrine carcinoma of the gallbladder are still unclear, which may differentiate with stem cells. This paper reports 6 cases of neuroendocrine carcinoma of the gallbladder treated in our hospital, and reviews the relevant literature at home and abroad. To explore the diagnosis and treatment of neuroendocrine carcinoma of the gallbladder. Objective: to analyze the progress of the disease and the diagnosis and treatment of 6 patients with neuroendocrine carcinoma of the gallbladder, and to review the literatures reported on neuroendocrine carcinoma of the gallbladder in recent years in China. Methods: the history, clinical data, laboratory examination and imaging examination of 6 patients with neuroendocrine carcinoma of the gallbladder were retrospectively analyzed in Qilu Hospital, Shandong University. To search CNKI (Chinese Journal Full-text Database), Chinese Biomedical Literature Database (CBMN), Wanfang Literature Database, with the keywords of "cholecystemic neuroendocrine tumor", "gallbladder neuroendocrine carcinoma", "gallbladder carcinoid" and so on. A total of 42 cases of GB-NECs were collected from 6 cases of cholecystic neuroendocrine carcinoma published in China since 1998, and selected selectively from relevant literatures and read their abstracts or full texts. The main points and research progress of clinical diagnosis and treatment of neuroendocrine carcinoma of gallbladder were analyzed and summarized. Results among 42 cases, 16 cases were male, 26 cases were female, the ratio of male to female was 1: 1.625. The onset age was 25-80 years old. A total of 40 out of an average of 57.7 years old and 42 cases reported their clinical manifestations, including abdominal pain, abdominal distension, abdominal distension, and other symptoms such as jaundice, anorexia, nausea and vomiting, abdominal mass, etc. Only 2 cases were complicated with carcinoid syndromes. Tumor markers such as carcinoembryonic antigen, carbohydrate antigen and alpha-fetoprotein were not specific in laboratory examination. The final diagnosis depends on histopathological examination combined with immunohistochemistry. The most important feature of immunohistochemistry is synaptophysin, chromogranin A (CgA) positive. The most effective treatment for cholecyst neuroendocrine carcinoma is radical resection of the tumor. Operation combined with chemotherapy can improve the prognosis of 42 patients. 24 patients were followed up for 55 days to 3 years and 10 months. Conclusion: 1. Neuroendocrine carcinoma of the gallbladder is rare. The clinical manifestations of GB-NECs were often infiltrated surrounding tissues and lymph node metastases 2. The imaging examination was not specific, and the laboratory examination had no obvious specific oncology index, so it was difficult to diagnose in the early stage. The diagnosis mainly depends on postoperative pathological examination, especially immunohistochemical examination. Surgical treatment is still the most effective treatment method. Chemotherapy combined with surgery in the treatment of neuroendocrine carcinoma of the gallbladder achieved a positive curative effect. Comprehensive treatment can prolong the survival time and improve the prognosis of patients with neuroendocrine carcinoma of the gallbladder, but the overall prognosis of the patients with neuroendocrine carcinoma of the gallbladder is still poor.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R735.8

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