本文選題：結(jié)直腸神經(jīng)內(nèi)分泌腫瘤 + 診斷��； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:對結(jié)直腸神經(jīng)內(nèi)分泌腫瘤患者的臨床病理資料進(jìn)行分析,并探討其與預(yù)后的關(guān)系。旨在為臨床結(jié)直腸神經(jīng)內(nèi)分泌腫瘤患者的診治提供一定的幫助。方法:回顧性分析2005年1月至2016年12月期間就診于河北醫(yī)科大學(xué)第四醫(yī)院的116例結(jié)直腸神經(jīng)內(nèi)分泌腫瘤患者的臨床病理資料及隨訪資料。統(tǒng)計分析患者臨床病理特征及其與預(yù)后的關(guān)系。結(jié)果:本研究共入組116例結(jié)直腸神經(jīng)內(nèi)分泌腫瘤患者,男性84例,女性32例,男女比例為2.63:1。發(fā)病年齡從22歲到77歲,平均57±11.5歲,高發(fā)年齡段50-70歲。73例為直腸神經(jīng)內(nèi)分泌腫瘤,43例為結(jié)腸神經(jīng)內(nèi)分泌腫瘤。其中14例(12.1%)位于盲腸、10例(8.6%)位于升結(jié)腸、5例(4.3%)位于橫結(jié)腸、6例(5.2%)位于降結(jié)腸、8例(6.9%)位于乙狀結(jié)腸。腫瘤的平均直徑為9.96±11.09mm(2mm-80mm)。98例腫瘤(84.5%)直徑≤10mm;10例(8.6%)10mm,≤20m;8例(6.9%)直徑20mm。其中腫瘤直徑20mm,≤50mm,6例;腫瘤直徑50mm,≤80mm,2例。其中結(jié)直腸NET G1:74例(63.79%),結(jié)直腸NET G2:32例(27.59%),結(jié)直腸NEC:7例(6.03%),MANEC:3例(2.58%)。T分期:T1為102例(87.93%);T2為2例(1.72%);T3為5例(4.31%);T4為7例(6.03%)。Syn(突觸囊泡蛋白,Synaptophysin)的陽性率為80%,CgA(嗜鉻粒蛋白A,Chromogranin A)的陽性率為45.1%,NSE(神經(jīng)元特異性烯醇化酶,neuron-specific enolase)的陽性率為60.2%。結(jié)腸及直腸NENs患者Syn的陽性率分別為78.05%、69.57%;結(jié)腸及直腸NENs患者CgA的陽性率分別為43.90%、45.83%;結(jié)腸及直腸NENs患者NSE的陽性率分別為64.29%、58.18%。本研究共統(tǒng)計了116例結(jié)直腸NENs患者,其中13例患者出現(xiàn)淋巴結(jié)轉(zhuǎn)移,103例未發(fā)現(xiàn)淋巴結(jié)轉(zhuǎn)移。遠(yuǎn)處轉(zhuǎn)移主要臟器為肝臟。其中1例發(fā)現(xiàn)時已有肝臟、肺臟、骨、遠(yuǎn)處多發(fā)淋巴結(jié)轉(zhuǎn)移,1例發(fā)現(xiàn)時已有肝臟、肺臟、腹腔多發(fā)淋巴結(jié)轉(zhuǎn)移,2例發(fā)現(xiàn)時已有肝臟、腹腔內(nèi)及腹膜后多發(fā)淋巴結(jié)轉(zhuǎn)移。本研究共統(tǒng)計了116例結(jié)直腸nens患者,其中101患者進(jìn)行了內(nèi)鏡下治療,行內(nèi)鏡黏膜吸引切除術(shù)(endoscopicmucosalresectionwithcap,emrc)的患者為56例,行內(nèi)鏡黏膜切除術(shù)(endoscopicmucosalresection,emr)的患者為31例,行內(nèi)鏡黏膜下剝離術(shù)(endoscopicsubmucosaldissection,esd)的患者為14例。其中2例(1.98%,2/101)在內(nèi)鏡切除術(shù)后,出現(xiàn)遲發(fā)性出血的并發(fā)癥,后經(jīng)止血藥物治療及內(nèi)鏡下止血治療,癥狀消失出院。11例患者行根治性手術(shù)切除;2例發(fā)現(xiàn)時已有肝臟轉(zhuǎn)移,行姑息性手術(shù)治療;其中1例發(fā)現(xiàn)時已有肝臟、肺臟轉(zhuǎn)移,給予化療及對癥治療;1例發(fā)現(xiàn)時已有肝臟、肺臟、骨轉(zhuǎn)移,發(fā)現(xiàn)后未治療,自動出院。116例患者中,101內(nèi)鏡下治療的患者,治療后定期復(fù)查,未給予特殊治療;另外15例患者,9例給予化療,1例發(fā)現(xiàn)時已有肝臟、肺臟、骨轉(zhuǎn)移,發(fā)現(xiàn)后未治療,自動出院;5例手術(shù)后出院,術(shù)后未行化療。116例結(jié)直腸nens患者中:失訪8例,有效隨訪數(shù)據(jù)共有108例,隨訪率為93.10%,隨訪到的患者中,疾病穩(wěn)定的患者99例,疾病進(jìn)展的患者7例,死亡的患者2例,其中,最長隨訪時間為118個月,最短隨訪時間2個月;中位隨訪時間為33.76±26.43個月。死亡2例,均為腫瘤進(jìn)展、復(fù)發(fā)、轉(zhuǎn)移引起的死亡�？偵媛蕿�98.28%。隨訪到的108例結(jié)直腸nens患者中,結(jié)直腸netg1:66例,平均生存時間為33.47±27.87個月,均為內(nèi)鏡治療的g1級的患者,全部存活,1年、3年、5年生存率均為100%。結(jié)直腸netg2:32例,平均生存時間為30.12±22.35個月,27例為內(nèi)鏡治療的患者全部存活,1年生存率為100%,3年生存率為95%,5年生存率為83%。結(jié)直腸nec:7例,平均生存時間為19.56±17.24個月,1年生存率為85.7%,3年生存率為42.9%,5年生存率為14.3%。manec:3例,平均生存時間為16.7±7.74個月,1年生存率為66.7%,3年生存率為33.3%,5年生存率為0%。腫瘤大小(p=0.028)、g分級(p=0.011)、腫瘤浸潤深度(t分期)(p=0.001)、淋巴結(jié)是否轉(zhuǎn)移(P=0.035)、Ki-67指數(shù)(P=0.001)及是否遠(yuǎn)處轉(zhuǎn)移(P=0.019)是影響患者預(yù)后的獨立因素。結(jié)論:結(jié)直腸NENs的發(fā)病率逐年上升,男性發(fā)病率明顯高于女性,好發(fā)部位為直腸;高發(fā)年齡段為50-70歲。結(jié)直腸NENs的臨床表現(xiàn)中類癌綜合征較少見。腫瘤的大小、分級、分期與結(jié)直腸NENs預(yù)后密切相關(guān)。腫瘤大小(P=0.028)、G分級(P=0.011)、腫瘤浸潤深度(T分期)(P=0.001)、淋巴結(jié)是否轉(zhuǎn)移(P=0.035)、Ki-67指數(shù)(P=0.001)、治療方法(P=0.022)、遠(yuǎn)處是否轉(zhuǎn)移(P=0.019)之間患者預(yù)后有明顯差異。腫瘤直徑≤10 mm,病理分級為G1級的,腫瘤分期T1,能夠接受內(nèi)鏡治療的預(yù)后好;腫瘤直徑20mm,Ki-67指數(shù)越高,腫瘤T分期、G分級越晚,有淋巴結(jié)、遠(yuǎn)處臟器轉(zhuǎn)移的,不能接受手術(shù)治療的患者預(yù)后差。
[Abstract]:Objective: to analyze the clinicopathological data of the patients with colorectal neuroendocrine tumors and to explore the relationship between them and the prognosis. The purpose is to provide some help for the diagnosis and treatment of the patients with colorectal neuroendocrine tumors. Methods: a retrospective analysis of 116 cases in the fourth hospital of Hebei Medical University from January 2005 to December 2016. The clinicopathological data and follow-up data of the patients with rectal neuroendocrine tumor. Statistical analysis of the clinicopathological features and the relationship with the prognosis. Results: 116 cases of colorectal neuroendocrine tumors were included in this study, 84 males and 32 females. The age of 2.63:1. was from 22 to 77 years, with an average of 57 11.5 years and high incidence. .73 cases aged 50-70 years were rectal neuroendocrine tumors and 43 cases were colon neuroendocrine tumors, of which 14 cases (12.1%) were located in the cecum, 10 (8.6%) located in the ascending colon, 5 (4.3%) located in the transverse colon, 6 (5.2%) located in the descending colon and 8 (6.9%) in the sigmoid colon. The average diameter of the tumor was 14 11.09mm (2mm-80mm).98 tumor (84.5%). Diameter was less than 10mm; 10 cases (8.6%) 10mm, less than 20m; 8 cases (6.9%) diameter 20mm. in which the diameter of the tumor was 20mm, < 50mm, 6 cases; the diameter of the tumor 50mm, < 80mm, 2 cases. Among them, the colorectal NET G1:74 (63.79%), colorectal NET G2:32 (27.59%), colorectal carcinoma (2.58%); 2.58%) For example (6.03%) the positive rate of.Syn (synaptic vesicle protein, Synaptophysin) was 80%, and the positive rate of CgA (chromogranin A, Chromogranin A) was 45.1%. The positive rate of NSE (neuron specific enolase, neuron-specific enolase) was 78.05% and 69.57%, respectively, for 60.2%. colon and rectal NENs patients. The positive rates were 43.90% and 45.83%, respectively, and the positive rate of NSE in colon and rectal NENs patients was 64.29% respectively. In this study, 116 cases of colorectal NENs were counted, of which 13 cases had lymph node metastasis, 103 cases had no lymph node metastasis. The main organ of distant metastasis was liver. Among them, 1 cases had liver, lung, bone and far away. 1 cases of lymph node metastasis were found in the liver, lungs and abdominal cavity, 2 cases had liver, intraperitoneal and retroperitoneal lymph node metastasis in the 1 cases, and 116 cases of colorectal cancer were found in this study, of which 101 were treated by endoscopy and underwent endoscopic mucosal attraction excision (endoscopicmucosalresectionwithca P, emrc) patients were 56, 31 patients with endoscopic mucosal resection (endoscopicmucosalresection, EMR) and 14 patients with endoscopic submucosal dissection (endoscopicsubmucosaldissection, ESD). 2 (1.98%, 2/101) had delayed bleeding complications after endoscopic resection, followed by hemostasis and endoscopy. Blood treatment, symptoms disappeared and discharged.11 patients for radical resection; 2 cases had liver metastases and palliative surgery; 1 of them had liver, lung metastasis, chemotherapy and symptomatic treatment, and 1 cases had liver, lung, bone metastases, untreated, 101 endoscopy. After treatment, the patients were rechecked regularly, and no special treatment was given. The other 15 patients, 9 patients received chemotherapy, 1 cases had liver, lung, bone metastases, untreated and discharged after discovery; 5 cases were discharged after operation, and after operation,.116 cases of colorectal NENS patients were not treated with chemotherapy, 8 cases were lost and 108 cases were followed up effectively, the follow-up rate of follow up was 93.10%. The patients were followed up with 99 patients with stable disease, 7 patients with progressive disease and 2 cases of death, of which the longest follow-up time was 118 months and the shortest follow-up time was 2 months; the median follow-up time was 33.76 + 26.43 months. 2 cases died of tumor progression, recurrence and metastasis. The total survival rate was 108 cases followed up at 98.28%.. The average survival time was 33.47 + 27.87 months in the colorectal NENS patients. The average survival time was 33.47 + 27.87 months. All were endoscopically treated patients with grade G1. All survived, 1 years, 3 years, and 5 year survival rates were netg2:32 cases of 100%. colorectal. The average survival time was 30.12 + 22.35 months. 27 patients survived endoscopically. The 1 year survival rate was 100%, 3 years. The survival rate was 95%, the 5 year survival rate was 83%. colorectal nec:7 cases, the average survival time was 19.56 + 17.24 months, the 1 year survival rate was 85.7%, the 3 year survival rate was 42.9%, the 5 year survival rate was 14.3%.manec:3 cases, the average survival time was 16.7 + 7.74 months, 1 year survival rate was 66.7%, and the survival rate was 0%. tumor size (p=0.028), G classification (p=0.028). P=0.011), the depth of tumor invasion (T staging) (p=0.001), lymph node metastasis (P=0.035), Ki-67 index (P=0.001) and distant metastasis (P=0.019) are independent factors affecting the prognosis of the patients. Conclusion: the incidence of NENs in colorectal cancer is increasing year by year, the incidence of male is obviously higher than that of women, the location of good hair is rectum, and the age of high incidence is 50-70 years. Carcinoid syndrome is rare in the clinical manifestations of intestinal NENs. Tumor size, classification, and staging are closely related to the prognosis of colorectal NENs. Tumor size (P=0.028), G grade (P=0.011), T stage (P=0.001), lymph node metastasis (P=0.035), Ki-67 index (P=0.001), treatment method (P=0.022), distant metastasis (P=0.019)) The prognosis of the patients was significantly different. The tumor diameter was less than 10 mm and the pathological grade was G1. The tumor stage was T1 and the prognosis of the endoscopy was better. The diameter of the tumor was 20mm, the higher the Ki-67 index, the T staging of the tumor, the later the G classification, the lymph nodes, the distant viscera metastasis, and the poor prognosis of the patients who were not treated by the operation.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.34

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