胆囊神经内分泌癌六例报道及相关文献复习

发布时间：2018-02-14 12:07

本文关键词： 胆囊神经内分泌癌根治性手术放疗化疗　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景:胆囊神经内分泌癌(GB-NECs)在临床上较为少见,患者通常无特异性症状及体征,可表现为腹痛、黄疸、类癌综合征、腹水、体重迅速下降等。胆囊神经内分泌癌的病因及发病机制至今尚不明确,可能与干细胞分化、胆囊粘膜细胞化生有关。本文对作者所在医院收治的6例胆囊神经内分泌癌病例进行报道,并对国内外相关文献进行复习,探讨胆囊神经内分泌癌患者的诊断与治疗。目的:分析6例胆囊神经内分泌癌患者的病情进展及诊疗经过,复习国内近年来关于胆囊神经内分泌癌的报道文献,为胆囊神经内分泌癌的临床诊治提供依据。方法:回顾性分析山东大学齐鲁医院收治的6例胆囊神经内分泌癌患者的病史、临床资料、实验室检查、影像学检查、手术治疗及辅助治疗方案;以"胆囊神经内分泌肿瘤"、"胆囊神经内分泌癌"、"胆囊类癌"等为检索词,检索CNKI(相关期刊论文)、中国生物医学文献数据库(CBM)、万方文献数据库,检索1998年以来国内发表的胆囊神经内分泌癌病例报道文献,选择性地选取相关文献并阅读其摘要或全文;加上作者所在医院收治的6例,总共收集42例GB-NECs病例,分析患者的临床资料并结合国内相关文献分析归纳胆囊神经内分泌癌临床诊断治疗的要点及研究进展。结果:42例患者中,男性16例,女性26例,男女比例为1:1.625。发病年龄25-80岁,平均57.7岁。42例中共有40例报道了患者的临床表现,以腹痛、腹胀最为常见(72.5%),其他症状还有黄疸、纳差、恶心呕吐、腹部包块等,仅2例合并类癌综合征。患者的实验室检查结果中癌胚抗原、糖类抗原、甲胎蛋白等肿瘤标记物无特异性,患者接受的辅助检查主要有超声、CT、MR,与胆囊癌等鉴别困难,最终确诊需要依靠病理组织检查联合免疫组化。免疫组化最重要的特征是突触素(Syn)、嗜铬粒蛋白A(CgA)阳性。胆囊神经内分泌癌最有效的治疗是肿瘤根治性切除术,手术联合化疗在一定程度上可以改善患者预后。42例患者中随访24例,存活时间为55天—3年10个月。结论:1.胆囊神经内分泌癌罕见,发现时往往已浸润周围组织及发生淋巴结转移;2.GB-NECs的临床表现、影像学检查无特异性,实验室检查亦无明显特异性的肿瘤学指标,早期诊断困难,主要依靠术后病理学检查尤其是免疫组化检查确诊;3.外科手术治疗仍是最有效的治疗手段,化疗联合手术治疗胆囊神经内分泌癌取得了肯定的疗效;4.采取综合治疗可以延长胆囊神经内分泌癌患者的生存期,改善预后,但目前胆囊神经内分泌癌患者的整体预后仍较差。
[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.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.8

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