目的比较腹腔镜手术与经肛门内镜微创手术(transanal endoscopic microsurgery,TEM)切除直肠神经内分泌肿瘤的短期疗效。方法回顾性分析2011年8月至2015年6月本院收治的24例肿瘤最大径小于2cm的直肠神经内分泌肿瘤患者的临床资料,其中...目的比较腹腔镜手术与经肛门内镜微创手术(transanal endoscopic microsurgery,TEM)切除直肠神经内分泌肿瘤的短期疗效。方法回顾性分析2011年8月至2015年6月本院收治的24例肿瘤最大径小于2cm的直肠神经内分泌肿瘤患者的临床资料,其中腹腔镜切除组13例,TEM切除组11例。比较两组患者切除标本的大小、切缘阳性率、术中失血量、中转开腹率、手术时间、首次排气时间、术后住院天数、术后并发症(穿孔、出血、感染、肛门功能、肠瘘等)、术后疼痛及围术期死亡情况等。结果两组患者的切缘阳性率、中转开腹率、术后并发症及围术期死亡情况比较差异无显著性(P>0.05)。TEM切除组患者切除的标本小于腹腔镜切除组[(3.45±0.48)cm vs (10.19±1.01)cm,P<0.05],手术时间短于腹腔镜切除组[(62.27±8.17)分钟vs (147.69±20.58)分钟,P<0.05],术后住院时间短于腹腔镜切除组[(4.00±0.89)天vs(9.84±1.46)天,P<0.05],术后首次排气时间早于腹腔镜切除组[(40.90±6.53)小时vs(63.38±9.61)小时,P<0.05],术中出血量少于腹腔镜切除组[(16.36±6.74)ml vs (51.54±23.39)ml,P<0.05]。TEM组术后12、24、48小时的疼痛视觉模拟评分均明显低于腹腔镜切除组(P<0.05)。结论对于肿瘤最大径小于2cm的直肠神经内分泌肿瘤,TEM切除与腹腔镜切除后患者的生存期及术后并发症无明显差异,且TEM切除具有手术时间短、创伤小、术后恢复快等优点,值得进一步推广应用。展开更多
Neurofibromatosis type 1(NF-1) is commonly associated with benign or malignant tumors in both the central and peripheral nervous systems. However, rare cases of NF-1-associated multiplerectal neuroendocrine tumors hav...Neurofibromatosis type 1(NF-1) is commonly associated with benign or malignant tumors in both the central and peripheral nervous systems. However, rare cases of NF-1-associated multiplerectal neuroendocrine tumors have been reported. This report describes a case of a 39 year old female with NF-1 and intermittent hematochezia as a primary symptom. Physical examination showed multiple subcutaneous nodules and café au lait spots with obvious scoliosis of the back. Imaging examinations and colonoscopy found malformation of the left external iliac vein and multiple gray-yellow nodules with varying sizes and shapes in the rectal submucosal layer. Histological and immunohistochemical results suggested multiple rectal neuroendocrine tumors, a rare disease with few appreciable symptoms and a particularly poor prognosis. The patient with NF-1 presented here had not only multiple rectal neuroendocrine neoplasms but also vascular malformations, scoliosis and other multiple system lesions. This case therefore contributes to improving clinical understanding, diagnosis and treatment of related complications for patients with NF-1 who present with associated medical conditions.展开更多
目的:分析直肠神经内分泌肿瘤(neuroendocrine tumor,NET)的临床诊断及治疗。方法 :对14例直肠NET临床及病理资料进行回顾分析并随访。结果:瘤体直径<1 cm 8例,≥1 cm且<2 cm 4例,2 cm 1例,3 cm 1例。瘤体直径<2 cm的12例,实...目的:分析直肠神经内分泌肿瘤(neuroendocrine tumor,NET)的临床诊断及治疗。方法 :对14例直肠NET临床及病理资料进行回顾分析并随访。结果:瘤体直径<1 cm 8例,≥1 cm且<2 cm 4例,2 cm 1例,3 cm 1例。瘤体直径<2 cm的12例,实施经肛门局部切除术3例,内镜下黏膜切除术9例。瘤体直径≥2 cm的2例,行低位直肠前切除术。13例获访者无死亡病例。结论:直肠NET生物学行为低度恶性,瘤体直径<2 cm的一般不侵犯肌层,也很少转移,大多数病例可经肛门局部切除或行内镜黏膜切除术治愈。展开更多
文摘目的比较腹腔镜手术与经肛门内镜微创手术(transanal endoscopic microsurgery,TEM)切除直肠神经内分泌肿瘤的短期疗效。方法回顾性分析2011年8月至2015年6月本院收治的24例肿瘤最大径小于2cm的直肠神经内分泌肿瘤患者的临床资料,其中腹腔镜切除组13例,TEM切除组11例。比较两组患者切除标本的大小、切缘阳性率、术中失血量、中转开腹率、手术时间、首次排气时间、术后住院天数、术后并发症(穿孔、出血、感染、肛门功能、肠瘘等)、术后疼痛及围术期死亡情况等。结果两组患者的切缘阳性率、中转开腹率、术后并发症及围术期死亡情况比较差异无显著性(P>0.05)。TEM切除组患者切除的标本小于腹腔镜切除组[(3.45±0.48)cm vs (10.19±1.01)cm,P<0.05],手术时间短于腹腔镜切除组[(62.27±8.17)分钟vs (147.69±20.58)分钟,P<0.05],术后住院时间短于腹腔镜切除组[(4.00±0.89)天vs(9.84±1.46)天,P<0.05],术后首次排气时间早于腹腔镜切除组[(40.90±6.53)小时vs(63.38±9.61)小时,P<0.05],术中出血量少于腹腔镜切除组[(16.36±6.74)ml vs (51.54±23.39)ml,P<0.05]。TEM组术后12、24、48小时的疼痛视觉模拟评分均明显低于腹腔镜切除组(P<0.05)。结论对于肿瘤最大径小于2cm的直肠神经内分泌肿瘤,TEM切除与腹腔镜切除后患者的生存期及术后并发症无明显差异,且TEM切除具有手术时间短、创伤小、术后恢复快等优点,值得进一步推广应用。
文摘Neurofibromatosis type 1(NF-1) is commonly associated with benign or malignant tumors in both the central and peripheral nervous systems. However, rare cases of NF-1-associated multiplerectal neuroendocrine tumors have been reported. This report describes a case of a 39 year old female with NF-1 and intermittent hematochezia as a primary symptom. Physical examination showed multiple subcutaneous nodules and café au lait spots with obvious scoliosis of the back. Imaging examinations and colonoscopy found malformation of the left external iliac vein and multiple gray-yellow nodules with varying sizes and shapes in the rectal submucosal layer. Histological and immunohistochemical results suggested multiple rectal neuroendocrine tumors, a rare disease with few appreciable symptoms and a particularly poor prognosis. The patient with NF-1 presented here had not only multiple rectal neuroendocrine neoplasms but also vascular malformations, scoliosis and other multiple system lesions. This case therefore contributes to improving clinical understanding, diagnosis and treatment of related complications for patients with NF-1 who present with associated medical conditions.
文摘目的:分析直肠神经内分泌肿瘤(neuroendocrine tumor,NET)的临床诊断及治疗。方法 :对14例直肠NET临床及病理资料进行回顾分析并随访。结果:瘤体直径<1 cm 8例,≥1 cm且<2 cm 4例,2 cm 1例,3 cm 1例。瘤体直径<2 cm的12例,实施经肛门局部切除术3例,内镜下黏膜切除术9例。瘤体直径≥2 cm的2例,行低位直肠前切除术。13例获访者无死亡病例。结论:直肠NET生物学行为低度恶性,瘤体直径<2 cm的一般不侵犯肌层,也很少转移,大多数病例可经肛门局部切除或行内镜黏膜切除术治愈。
