【作者】 秦利花；

【导师】 王彩花；

【作者基本信息】 浙江大学 ， 内科学， 2009， 硕士

【摘要】 目的:探讨胃肠道类癌的临床表现、诊断方法、治疗方法及误诊病例分析,以提高对胃肠道类癌的认识及诊治。方法:回顾分析我院自2004.1-2008.10月收治的具有完整病例的13例胃肠道类癌的临床资料。结果:13例类癌中,平均年龄43.3岁,病程6月-10年余不等,平均病程18.7月余。直肠类癌7例(53.8%),阑尾类癌3例(23.1%),食管类癌1例(7.7%),胃类癌1例(7.7%),十二指肠乳头类癌1例(7.7%)。临床症状中腹痛多见,占61.5%,其次为大便习惯改变,占53.8%,恶心呕吐占23.1%,消化道出血占15.4%。4例行CT检查,2例发现病灶或转移灶,2例发现有异常。10例行内镜检查,10例发现病变。6例经内镜下活检病理明确,7例经手术后病理明确。确诊前各有1例误诊为腺癌,粘膜下肿瘤,小细胞癌,黏膜慢性炎症。3例阑尾类癌均误诊为阑尾炎。12例经外科手术治疗,其中1例阑尾类癌伴淋巴结转移者术后氟尿嘧啶化疗1次。直肠类癌1例伴肝脏转移者行内镜下摘除直肠类癌后姑息化疗4次。结论:胃肠道类癌无特异性临床表现,腹痛、大便习惯改变多见,诊断较为困难,病理活检是重要的检查方法,但仍需结合CT等检查。胃肠道类癌以手术为主要治疗方式,必要时需联合多种治疗方法,部分类癌可行内镜下治疗。更多还原

【Abstract】 Objective:To discuss the clinical manifestation,diagnostic methods,the therapy of gastrointestinal tract carcinoid tumors and analyse cases which were misdiagnosed,in order to improve the level of recognition and diagnosis.Methods:The data of 13 cases of gastrointestinal tract carcinoid tumors which were hospitalized during Jan,2004 and Oct,2008 were analysed retrospectively.Results:In our results,the average age of patients was 43.3.The internal from onset to be diagnosed was from 6 months to 10 years,with 18.7 months as average.The rectum is the most common site of carcinoids(53.8%),followed by the appendix (23.1%),then the esophagus,stomach and duodenal papilla is 7.7%respectively.The most common symptoms were abdominal pain(61.5%);changing of the habits of defecation(53.8%),nausea and vomiting(23.1%),bleeding of gastrointestinal tract (15.4%).CT was performed,in 4 cases,primory or metastasis was detected in 2 cases, and 2 were abnormal.Endoscopy was performed in 10 cases,positive findings were detected in 10 cases.6 cases got final diagnosis per endoscopy and biopsy,7 patients by operation and biopsy.Before final diagnosis,there was 1 case misdiagnosed for adeno-carcinoma,submucous tumor,small cell carcinoma and chronic inflammation of mucous membrane respectively,the carcinoids of appendix were all misdiagnosed for appendicitis.12 patients were taken a surgical resection,the rectum with hepatic metastases perfered four times of palliative systemic chemotherapeutic after endoscopic resection of primary carcinoids,another appendix carcinoid with lymph node involvement applied 5-fluorouracil after appendectomy.Conclusions:The clinical manifestations of gastrointestinal tract carcinoid tumors were non-specific.Abdominal pain and changing of the habits of defecation are the most commen symptoms.These neoplasms pose a diagnostic challenge.Biopsy is an imporment method to diagnose,but need to combined with CT and so on.Operation is the main approach to cure,and may need symphysial managements necessary,some of the carcinoids maybe cured by endoscope.更多还原