本文選題：直腸神經內分泌腫瘤　切入點：臨床特點　出處：《鄭州大學》2017年碩士論文　論文類型：學位論文

【摘要】：背景胃腸胰神經內分泌腫瘤(Gastroenteropancreatic neuroendocrine tumors,GEP-NETs)是起源于腸道彌散神經系統(tǒng)中的腸嗜鉻細胞的一組生長緩慢、低度惡性的異質性腫瘤。有研究表明,近年來GEP-NETs發(fā)病率呈現明顯增長趨勢,約占所有神經內分泌腫瘤的70%。在胃腸道及胰腺所有的發(fā)病部位中,直腸為主要的好發(fā)部位。隨著臨床醫(yī)務工作者對該類疾病的認識增加,內鏡檢出率及臨床診斷率明顯提高,在治療方面有了新的突破。目前關于直腸神經內分泌腫瘤的診斷及治療方面的研究已經成了國內外的研究熱點方向。目的本研究通過對我院84例直腸神經內分泌腫瘤患者的臨床特點、病理特征、預后等方面進行分析,提高對該類疾病的深入了解,以便提高對其診治水平。方法收集2012年4月到2015年4月共3年間鄭州大學第一附屬醫(yī)院經內鏡組織標本活檢或手術病理檢查確診為直腸神經內分泌腫瘤的84份患者的臨床資料,回顧性分析其在性別、年齡、臨床表現、腫瘤直徑、部位、浸潤深度、病理分級、分期、診斷、治療及預后等方面的特點。應用SPSS19.0統(tǒng)計軟件對所收集的數據進行統(tǒng)計分析;計量資料統(tǒng)計描述用均數±標準差(?x±s)表示;計數資料采用χ2檢驗對不同分組資料進行檢驗分析;隨訪時間采用中位數(最小值~最大值)表示;總體生存率分析采用Kaplan-Meier法來評估患者在隨訪期內生存預后情況。結果(1)直腸神經內分泌腫瘤男性較女性多發(fā),40歲以上患者多見,占91.7%(77/84),臨床表現無明顯特異性,容易誤診或漏診。(2)不同病理分級的直腸神經內分泌腫瘤在性別、年齡、發(fā)病部位、嗜鉻顆粒蛋白(CgA)和神經元特異性烯醇化酶(NSE)陽性率方面進行比較,差異無統(tǒng)計學意義(P0.05);在腫瘤直徑、浸潤深度、TNM分期、淋巴結轉移方面進行比較,差異有統(tǒng)計學意義(P0.05)。(3)應用Kaplan-Meier法評估總體生存率表示:直腸神經內分泌腫瘤2年總體生存率為95.1%,轉移發(fā)生率低,預后較好。結論直腸神經內分泌腫瘤是一種少見的,臨床表現不典型的低度惡性腫瘤;明確診斷需要病理組織檢查,特別是免疫組化的協助;手術治療包括內鏡治療仍是根治的首選方式;總體生存率較高、預后較好,腫瘤直徑、浸潤深度、病理分級、分期、治療方式的選擇可能是影響其預后的主要因素。
[Abstract]:Background Gastroenteropancreatic neuroendocrine tumors (Gastroenteropancreatic neuroendocrine tumors) is a group of intestinal chromaffin cells derived from the intestinal diffuse nervous system. About 70% of all neuroendocrine tumors. The rectum is the most common site in all the gastrointestinal and pancreatic diseases. With the increase of clinical medical workers' knowledge of the disease, the detection rate of endoscopy and the rate of clinical diagnosis have increased significantly. There has been a new breakthrough in the treatment of rectal neuroendocrine tumors. At present, the diagnosis and treatment of rectal neuroendocrine tumors has become a hot research direction at home and abroad. Clinical characteristics of tumor patients, The pathological features, prognosis and other aspects of the analysis, to improve the understanding of this kind of disease, Methods the clinical data of 84 patients with rectal neuroendocrine neoplasms diagnosed by endoscopic biopsy or surgical pathology in the first affiliated Hospital of Zhengzhou University from April 2012 to April 2015 were collected. The characteristics of sex, age, clinical manifestation, tumor diameter, location, depth of invasion, pathological grade, stage, diagnosis, treatment and prognosis were analyzed retrospectively. The collected data were statistically analyzed by SPSS19.0 software. Mean 鹵standard deviation for statistical description of measurement data? X 鹵s, 蠂 2 test was used to test and analyze the data of different groups, and the median value (minimum value to maximum value) was used to indicate the follow-up time. The overall survival rate was evaluated by Kaplan-Meier method during the follow-up period. Results 1) rectal neuroendocrine neoplasms were more common in male than in female patients over 40 years of age, accounting for 91.7% 77 / 84%, with no obvious specificity in clinical manifestations. The positive rates of sex, age, location, chromaffin protein (CgA) and neuron specific enolase (NSE) of rectal neuroendocrine tumors with different pathological grades were compared. There was no significant difference in tumor diameter, depth of invasion, TNM stage and lymph node metastasis. The overall survival rate of rectal neuroendocrine tumors was 95.1, the incidence of metastasis was low, and the prognosis was good. Conclusion rectal neuroendocrine tumors are rare. Atypical low-grade malignant tumors with atypical clinical manifestations; definite diagnosis needs pathological examination, especially with the help of immunohistochemistry; surgical treatment, including endoscopic treatment, is still the first choice for radical cure; overall survival rate is high, prognosis is better, tumor diameter is better, The depth of invasion, pathological grade, stage and treatment mode may be the main factors affecting the prognosis.
【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.37

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