本文選題：神經(jīng)內(nèi)分泌腫瘤 + 肺癌��； 參考：《山東大學(xué)》2017年碩士論文

【摘要】：目的:肺神經(jīng)內(nèi)分泌腫瘤(PNET)發(fā)生于支氣管粘膜上皮的嗜銀細(xì)胞,是一類具有相近的病理形態(tài)、超微結(jié)構(gòu)、免疫組化以及分子特征的惡性腫瘤,約占所有肺癌的20%。近年來其發(fā)病率以及死亡率逐年不斷地上升,隨著對該疾病的認(rèn)識(shí)不斷深入,現(xiàn)如今已成為多學(xué)科領(lǐng)域的研究熱點(diǎn)。本文通過對PNET的病理特點(diǎn)、臨床表現(xiàn)、輔助檢查、診斷標(biāo)準(zhǔn)、治療方法及預(yù)后等進(jìn)行整理和分析,旨在提高對此類疾病的認(rèn)識(shí)和診治水平。方法:回顧性統(tǒng)計(jì)山東省立醫(yī)院胸外科自2010年1月一2016年12月收治的42例肺神經(jīng)內(nèi)分泌腫瘤病人的臨床病例資料,進(jìn)行整理、統(tǒng)計(jì)和分析。結(jié)果:本組42例患者中,有27例實(shí)施了手術(shù)治療,其中18例病人施行了肺葉切除術(shù),7例病人施行了單側(cè)全肺的切除術(shù),2例病人實(shí)施了肺楔形或肺段切除術(shù);同時(shí),采用了新輔助化療的病人有5例,單純手術(shù)的有6例,手術(shù)+術(shù)后輔助化療的病人有16例。此外,15例病人僅僅進(jìn)行了單純性的化療,采用的藥物方案為EP方案(順鉑+依托泊苷)。術(shù)后病理結(jié)果:根據(jù)WHO(世界衛(wèi)生組織)2004年病理診斷標(biāo)準(zhǔn),SCLC有31例,LCNEC有7例,TC有3例,AC有1例;根據(jù)2010年AJCC(美國抗癌聯(lián)合會(huì))發(fā)布的第七版的腫瘤TNM分期標(biāo)準(zhǔn),Ⅰ期病人有7例,Ⅱ期病人有11例,Ⅲ期病人有14例,Ⅳ期病人有10例。本組42例患者均通過電話隨訪,共隨訪40例,失訪2例,隨訪時(shí)間從2016年1月至2016年12月。截至所有病人電話隨訪結(jié)束,本組所有42例PNET病人的OS中最短者為2個(gè)月,最長者為80個(gè)月,平均OS為19個(gè)月。結(jié)論:PNET約占所有原發(fā)性肺部惡性腫瘤的1/5,可分為4個(gè)亞組:典型類癌(TC)、非典型類癌(AC)、大細(xì)胞神經(jīng)內(nèi)分泌癌(LCNEC)以及小細(xì)胞肺癌(SCLC)。SCLC最常見,其次LCNEC,類癌較少見。常見的臨床表現(xiàn)有咳嗽、咯血、阻塞性肺炎等癥狀,少數(shù)可伴發(fā)副瘤綜合征如異位抗利尿激素分泌異常綜合征(SIADH)、Cushing,s綜合征、Lambert-Eaton綜合征(LEMS)等。PNET的不同種類亞組在影像學(xué)中的表現(xiàn)不同。手術(shù)切除是治療類癌的最主要的手段,局限期小細(xì)胞肺癌的標(biāo)準(zhǔn)治療是早期胸部放療聯(lián)合EP方案化療,預(yù)防性應(yīng)用腦照射。TC預(yù)后較好,AC和LCNEC的預(yù)后較差,SCLC的預(yù)后最差。
[Abstract]:Objective: lung neuroendocrine tumor (PNET) is a kind of malignant tumor with similar pathological morphology, ultrastructure, immunohistochemistry and molecular characteristics, which accounts for about 20% of all lung cancer. In recent years, the morbidity and mortality rate have been increasing year by year. With the deepening of the understanding of the disease, it has become a research hotspot in multi-disciplinary field. In this paper, the pathological features, clinical manifestations, auxiliary examination, diagnostic criteria, treatment methods and prognosis of PNET were analyzed in order to improve the understanding, diagnosis and treatment of these diseases. Methods: the clinical data of 42 patients with lung neuroendocrine tumors admitted from January 2010 to December 2016 in the Department of Thoracic surgery in Shandong Provincial Hospital were analyzed retrospectively. Results: of the 42 patients, 27 received surgical treatment, 18 underwent lobectomy, 7 underwent unilateral total lung resection and 2 underwent wedge or segmental lung resection. There were 5 cases of neoadjuvant chemotherapy, 6 cases of simple operation and 16 cases of postoperative adjuvant chemotherapy. In addition, only 15 patients underwent simple chemotherapy with EP regimen (cisplatin etoposide). Postoperative pathological results: according to WHO (World Health Organization) 2004 pathological diagnosis criteria, 31 cases of LCNEC were diagnosed, 7 cases of TC, 3 cases of AC, 1 case of AC, and 7 cases of stage I patients according to the seventh edition of cancer TNM staging standard published by AJCC (American Anticancer Federation) in 2010. There were 11 cases of stage 鈪，

本文編號(hào)：1943980