84例直肠神经内分泌肿瘤的临床病理特征及治疗分析

发布时间：2018-03-18 06:25

本文选题：直肠神经内分泌肿瘤　切入点：临床特点　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景胃肠胰神经内分泌肿瘤(Gastroenteropancreatic neuroendocrine tumors,GEP-NETs)是起源于肠道弥散神经系统中的肠嗜铬细胞的一组生长缓慢、低度恶性的异质性肿瘤。有研究表明,近年来GEP-NETs发病率呈现明显增长趋势,约占所有神经内分泌肿瘤的70%。在胃肠道及胰腺所有的发病部位中,直肠为主要的好发部位。随着临床医务工作者对该类疾病的认识增加,内镜检出率及临床诊断率明显提高,在治疗方面有了新的突破。目前关于直肠神经内分泌肿瘤的诊断及治疗方面的研究已经成了国内外的研究热点方向。目的本研究通过对我院84例直肠神经内分泌肿瘤患者的临床特点、病理特征、预后等方面进行分析,提高对该类疾病的深入了解,以便提高对其诊治水平。方法收集2012年4月到2015年4月共3年间郑州大学第一附属医院经内镜组织标本活检或手术病理检查确诊为直肠神经内分泌肿瘤的84份患者的临床资料,回顾性分析其在性别、年龄、临床表现、肿瘤直径、部位、浸润深度、病理分级、分期、诊断、治疗及预后等方面的特点。应用SPSS19.0统计软件对所收集的数据进行统计分析;计量资料统计描述用均数±标准差(?x±s)表示;计数资料采用χ2检验对不同分组资料进行检验分析;随访时间采用中位数(最小值~最大值)表示;总体生存率分析采用Kaplan-Meier法来评估患者在随访期内生存预后情况。结果(1)直肠神经内分泌肿瘤男性较女性多发,40岁以上患者多见,占91.7%(77/84),临床表现无明显特异性,容易误诊或漏诊。(2)不同病理分级的直肠神经内分泌肿瘤在性别、年龄、发病部位、嗜铬颗粒蛋白(CgA)和神经元特异性烯醇化酶(NSE)阳性率方面进行比较,差异无统计学意义(P0.05);在肿瘤直径、浸润深度、TNM分期、淋巴结转移方面进行比较,差异有统计学意义(P0.05)。(3)应用Kaplan-Meier法评估总体生存率表示:直肠神经内分泌肿瘤2年总体生存率为95.1%,转移发生率低,预后较好。结论直肠神经内分泌肿瘤是一种少见的,临床表现不典型的低度恶性肿瘤;明确诊断需要病理组织检查,特别是免疫组化的协助;手术治疗包括内镜治疗仍是根治的首选方式;总体生存率较高、预后较好,肿瘤直径、浸润深度、病理分级、分期、治疗方式的选择可能是影响其预后的主要因素。
[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 卤standard deviation for statistical description of measurement data? X 卤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.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.37

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