十二指肠乳头神经内分泌瘤3例报告

Neuroendocrine tumor of duodenal papilla: a clinical analysis of 3 cases

关键词:  十二指肠  神经内分泌瘤  诊断  手术

Key words:  duodenum  neuroendocrine carcinoma  diagnosis  operation

摘要:

目的　探讨十二指肠乳头神经内分泌瘤的临床病理学特征、诊断及治疗方法。　方法　回顾性分析3例十二指肠乳头神经内分泌瘤患者的临床资料，男性2例，女性1例，发病年龄68、66和52岁；主要临床表现分别为上腹痛，腹泻及消化道出血；行影像学检查提示2例十二指肠降部占位，3例胃十二指肠镜检示十二指肠乳头病变，活检病理为神经内分泌瘤。3例均行胰十二指肠切除术（PD术），分析患者术后临床病理特征及预后。　结果　　术后病理发现2例为十二指肠乳头神经内分泌肿瘤G1级，1例为G2级。3例患者均得到随访，1例术后7个月仍无瘤生存，1例术后生存>5年，1例术后4年8个月死于复发。　结论　　十二指肠乳头神经内分泌瘤临床较罕见，无特异性临床表现，术前十二指肠镜检有助于明确诊断，积极的手术治疗是主要的治疗方式。

Abstract:

Objective To study the clinicopathological features, diagnosis and surgical treatment of duodenal papilla neuroendocrine tumors (DPNETs). Methods Clinical data of 3 DPNET patients and their surgical treatment outcome were retrospectively analyzed with related literatures reviewed. The patients were 68,66 and 52 years old. Main clinical symptoms included abdominal pain, diarrhea and upper gastrointestinal bleeding. Imaging studies of 2 cases revealed mass lesions in the descending part of duodenum. Esophagogastroduodenoscopy (EGD) of the 3 cases indicated duodenal papilla lesions. Biopsies demonstrated neuroendocrine tumors by pathology. Results All patients underwent pancreaticoduodenectomy (PD). Pathological reports were G1 grade in 2 cases and G2 grade in 1 case. The patients were followed up after operation. Of the 3 patients, two patients survived while the other patient died due to recurrence after 4 years and 8 months of surgery. Conclusion Duodenal papilla neuroendocrine tumor is relatively rare and does not have specific clinical manifestations. Preoperative EGD is helpful for diagnosis. Surgical resection is the mainstay of treatment.