支气管肺类癌致异位ACTH综合征的临床诊治分析

发布时间：2018-02-01 03:48

  本文关键词： 支气管肺类癌 异位ACTH综合征 诊断 手术治疗 预后　出处：《北京协和医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的探讨支气管肺类癌致异位促肾上腺皮质激素(Adrenocorticotropic Hormone,ACTH)综合征的疾病特点、诊治方法及预后情况。方法选取2007年3月至2016年5月间经北京协和医院诊治并由手术病理证实的支气管肺类癌引起的异位ACTH综合征20例,其中男性13例,女性7例。搜集并整理20例患者的重要临床数据,并进行统计分析。结果20例患者就诊时的平均年龄为38.85± 15.31岁(13～70岁),中位病程15个月(范围:1～156个月)。所有患者均存在库欣综合征的典型临床表现,均由胸部CT定位胸部病变。手术治疗后血清皮质醇及血ACTH浓度均明显下降。术后并发症3例(15%),均为严重肺部感染。随访18例患者,中位随访时间31.5月(范围:12月～122月),其中典型类癌13例、不典型类癌5例,Ⅰa期7例、Ⅰb期1例、Ⅱa期2例、Ⅲa期8例,1例行术后放疗、3例行术后化疗。随访时间内,1例复发转移,无死亡病例。典型类癌与不典型类癌的Ki67、术后血F、肿瘤大小,吸烟与否的肿瘤大小,及淋巴结转移与否的病程,差别有统计学意义。术前血ACTH与年龄存在正相关,与血钾存在负相关。结论1.支气管肺类癌所致异位ACTH综合征是一种极为罕见的疾病,早期诊断及治疗对临床医师存在很大难度,需要多种的检查手段及多专科医师共同诊治;2.胸部CT是发现病变并评估手术可行性的重要方法;3.早期手术切除异位分泌ACTH肿瘤是治疗该病的有效手段,且大多可获长期生存;4.不常规推荐对病变完全切除的PTC或PAC患者进行辅助治疗,无论其是否有区域淋巴结转移;5.病理分型及分期可能是影响预后的因素,但需要积累更多的数据证实;6.高龄女性可能更容易发生严重低血钾,而术后血F可能是与预后相关的预测因子。
[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 卤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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