Böttger T
Klinik und Poliklinik für Allgemein- und Abdominalchirurgie, Johannes Gutenberg-Universität Mainz.
Zentralbl Chir. 2001 Sep;126(9):676-81. doi: 10.1055/s-2001-18235.
More than 70% of all carcinoids are localized in the gastrointestinal tract. Carcinoids of the upper, middle and lower intestines have to be distinguished ontogenetically. The classification according to Capella takes into account the size of the tumor (< 0.9 cm; 1-2 cm; > 2 cm), the grade of invasion of other structures, the grade of angioinvasion, the biologic behaviour, the grade of differentiation and the hormonal activity of the tumor. A carcinoid-syndrome is rarely found. Carcinoids of the small intestine occur multiple in 30-50% and in 20-30% a second malignant tumor is seen. In carcinoids of the colon this percentage is even higher (25-40%). The therapy of carcinoids depends on the size of the tumor and consecutively on the risk of metastasis. A local excision or non-oncologic radical operative procedure is justified in carcinoids smaller than 1 cm. In tumors 1-2 cm in size an individual decision has to be made. Larger tumors should be operated according to oncologic standards. Palliative resections, even of the liver, may be indicated to relieve the symptoms of a carcinoid-syndrome or, to prevent ileus or bleeding in the gastrointestinal tract. The prognosis of gastrointestinal carcinoids is heterogenous: The five-year-survival-rate of appendix-carcinoids is 85.9% over all stages. In rectal carcinoids this rate amounts to 72.2%, in carcinoids of the small intestines to 55.4% and in colon-carcinoids to 41.6%. Carcinoids of the stomach have a five-year-survival-rate of 64.3% in the absence of metastases. Within carcinoids of the stomach type III-tumors have the worst prognosis with a median survival time of 6.5 months.
所有类癌中超过70%位于胃肠道。必须从个体发生学角度区分上、中、下肠道的类癌。根据卡佩拉分类法，要考虑肿瘤大小（<0.9厘米；1 - 2厘米；>2厘米）、对其他结构的侵犯程度、血管侵犯程度、生物学行为、分化程度以及肿瘤的激素活性。类癌综合征很少见。小肠类癌30% - 50%为多发，20% - 30%可见第二原发性恶性肿瘤。在结肠类癌中，这一比例甚至更高（25% - 40%）。类癌的治疗取决于肿瘤大小，进而取决于转移风险。对于小于1厘米的类癌，局部切除或非肿瘤根治性手术是合理的。对于1 - 2厘米大小的肿瘤，必须做出个体化决策。较大的肿瘤应按照肿瘤学标准进行手术。即使是肝脏的姑息性切除，也可能适用于缓解类癌综合征的症状，或预防胃肠道梗阻或出血。胃肠道类癌的预后各不相同：阑尾类癌在所有阶段的五年生存率为85.9%。直肠类癌这一比例为72.2%，小肠类癌为55.4%，结肠类癌为41.6%。胃类癌在无转移时五年生存率为64.3%。在胃类癌中，III型肿瘤预后最差，中位生存时间为6.5个月。
