肝脏神经内分泌肿瘤的临床分析

发布时间：2018-08-07 21:42

【摘要】：目的:肝脏是原发于胃肠道和胰腺的神经内分泌肿瘤常见的转移部位,但也有极少数的神经内分泌肿瘤可原发于肝脏。本研究通过收集我院2012年1月～2017年1月期间住院治疗的40例肝脏神经内分泌肿瘤患者的临床资料,回顾分析原发性及转移性肝脏神经内分泌肿瘤的诊断、治疗经过,并进行随访,旨在通过本实验研究,提高对转移而来的肝脏神经内分泌肿瘤和原发性肝脏神经内分泌肿瘤的临床病理学特征,分级,治疗方案和预后的认识。方法:收集2012年1月至2017年1月期间在我中心接受治疗的40例肝脏神经内分泌肿瘤患者的临床资料。(1)收集登记患者的一般特点:年龄、性别、吸烟饮酒史、家族肿瘤史、既往病史及相关检查、检验(腹部B超、CT、内镜检查、血液检验等);(2)病理生物学特征:常规HE染色,显微镜观察肿瘤细胞聚集状态、大小、形态、核分裂像;免疫组织化学染色检查,统计肿瘤位置、肿瘤直径大小,肿瘤淋巴结转移率。(3)肝脏神经内分泌肿瘤的治疗情况:包括手术治疗,是否行肝动脉栓塞治疗、射频消融、药物化疗等;(4)预后随访患者生存状况。整理临床资料,使用Graphpad prism软件7.0版进行统计分析。结果:原发性和转移性肝脏神经内分泌肿瘤在早期并没有特异性的临床表现,大多数患者都是通过体检时发现。原发性肝脏神经内分泌肿瘤的发病没有明显性别差异,而转移性神经内分泌肿瘤的发病常多见于50～59岁的老年男性。两者的诊断依赖于免疫组化检查和有无明确的肝外原发灶。免疫组化中的突触泡蛋白,嗜铬粒蛋白A和CD56等应该作为准确诊断肝神经内分泌肿瘤的重要依据。原发性以及转移性肝神经内分泌肿瘤的预后主要与其可切除性和病理分级相关,最为推荐的治疗方法是肿瘤的完整切除。在术前或者术后运用包括动脉化疗栓塞,射频消融和化疗的综合治疗可以改善患者的生存预后。结论:PHNET和MHNET均属于早期缺乏特异性临床表现的神经内分泌肿瘤,其诊断依赖于免疫组化和有无肝外原发灶。,病理分级和能否手术治疗是影响预后的重要因素,手术切除是治疗PHNET和MHNET的最有效的治疗方式。。
[Abstract]:Objective: the liver is a common metastatic site of neuroendocrine tumors in the gastrointestinal tract and pancreas, but a few neuroendocrine tumors can be found in the liver. In this study, we collected the clinical data of 40 patients with liver neuroendocrine neoplasms hospitalized in our hospital from January 2012 to January 2017, and retrospectively analyzed the diagnosis and treatment of primary and metastatic hepatic neuroendocrine tumors. The aim of this study was to improve the understanding of the clinicopathological features, classification, treatment scheme and prognosis of metastatic neuroendocrine tumors and primary hepatic neuroendocrine tumors. Methods: the clinical data of 40 patients with liver neuroendocrine neoplasms treated in our center from January 2012 to January 2017 were collected. (1) the general characteristics of the patients were collected: age, sex, smoking and drinking history, family cancer history. The pathobiological features of); (_ 2 were as follows: routine HE staining, microscopic observation of tumor cell aggregation, size, morphology and mitosis; Immunohistochemical staining, tumor location, tumor diameter, tumor lymph node metastasis rate. (3) liver neuroendocrine tumor treatment: including surgical treatment, whether hepatic artery embolization treatment, radiofrequency ablation, (4) survival status of patients with prognosis and follow-up. Collate clinical data, use Graphpad prism software 7.0 version for statistical analysis. Results: primary and metastatic liver neuroendocrine tumors had no specific clinical manifestations at early stage, and most of the patients were found at physical examination. The incidence of primary hepatic neuroendocrine tumors has no significant gender difference, while metastatic neuroendocrine tumors are more common in 50 ~ 59 years old men. The diagnosis of both depends on immunohistochemical examination and the presence of definite extrahepatic primary lesions. The synaptic vesicle protein, chromogranin A and CD56 in immunohistochemistry should be the important basis for accurate diagnosis of hepatic neuroendocrine tumors. The prognosis of primary and metastatic hepatic neuroendocrine tumors is mainly related to their resectability and pathological grade. The most recommended treatment is complete resection of the tumor. Preoperative and postoperative treatment including arterial chemoembolization, radiofrequency ablation and chemotherapy can improve survival and prognosis of patients. Conclusion both of them are neuroendocrine tumors with no specific clinical manifestations in the early stage. The diagnosis depends on immunohistochemistry and the presence of extrahepatic primary lesions. Pathological grading and surgical treatment are important factors affecting the prognosis. Surgical resection is the most effective treatment for PHNET and MHNET.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7

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