胃肠道类癌内镜下诊治与预后分析

摘要

Objective To evaluate the diagnosis, treatment and prognosis of gastrointestinal carcinoids under endoscope. Methods 37 patients diagnosed as gastrointestinal carcinoid from Mar. 2000 to Mar. 2007 were collected. Clinical manifestation, endoscopic findings, treatment and prognosis were analyzed retrospectively. Results Tumor diameter was 3 ~ 82 mm, the average was (20 ±16. 3) mm. There were 12 cases of infiltration into the submucosa, 15 cases of infiltration into the muscle layer, 10 cases of infiltration into serosal layer and 5 cases of lymph node metastasis. Endoscopic findings; there were 13 cases of the color colors similar to normal mucosa, 22 cases of yellow-white and 2 cases of red in the mucosal surface. There were 32 cases of lesions mucosal smooth, 3 cases of the mucosal erosion and 2 cases of mucosal ulcers. There were 32 cases of tough or moderate of texture and 5 cases of crisp and easy bleeding. The average survival time in less than 20 mm of lymph node metastasis group (86. 3 ± 37. 6) months was longer than that in more than 20 mm lymph node metastasis group [(61.2 ±22.8) months, P <0. 001 ] . The average survival time in less than muscle of infiltration group (81. 5 ±29. 0) months was longer than that in more than muscle of infiltration group [ (50.7 ±10.4) months, P = 0. 002 ] . Conclusion Although the general prognosis of gastrointestinal carcinoid is relatively good, it has therioma characteristics, such as tissue infiltration and ymph node metastasis. The prognosis depends mainly on the size and depth of invasion of carcinoid.%目的 探讨胃肠道类癌内镜下诊治与预后.方法 选取本院2000年3月-2007年3月诊治的37例胃肠道类癌患者,对其内镜表现、治疗情况及预后情况进行分析总结.结果 肿瘤直径3～82 mm,平均直径(20±16.3)mm,其中浸润至黏膜下层者12例,至肌层者15例,至浆膜层者10例;伴有淋巴结转移5例.镜下表现:颜色与正常黏膜颜色相似者13例、黏膜表面为黄白色22例、红色2例.病灶黏膜光滑32例、黏膜呈糜烂3例、黏膜溃疡2例.质地较韧或中等者占多数,为32例;质地较脆且易出血者有5例.5例出现淋巴结转移患者中,以肿瘤直径不同分为大于20 mm组与小于20 mm组.小于20 mm组淋巴结转移1例,平均生存时间(86.3±37.6)个月;大于20 mm组淋巴结转移4例,平均生存时间(61.2±22.8)个月,两者比较有显著的统计学差异(P＜0.001).以浸润程度不同分为不超过肌层组与超过肌层组,结果发现浸润程度不超过肌层组平均生存时间(81.5±29.0)个月,浸润程度超过肌层组平均生存时间(50.7±10.4)个月,两组比较有显著的统计学差异(P=0.002).结论 消化道类癌虽然一般预后较为良好,但是一种潜在的恶性肿瘤,有着恶性肿瘤的一些组织浸润、淋巴结转移等特征.镜下单纯从形态学上难以区分类癌的良恶性.其预后主要取决于类癌的大小及浸润的深度.