Partensky C, Landraud R, Velecela E, Souquet J C
Service de Chirurgie Digestive, Hôpital E. Herriot, Lyon.
Ann Chir. 1990;44(1):34-8.
The authors report their experience with resection of small bowel carcinoid tumors associated with diffuse hepatic metastases. Nine patients were operated during the last ten years. A carcinoid syndrome was present biologically in every case and clinically in 8 cases. The tumor was removed in every case, either by right hemicolectomy (n = 6), or by small bowel resection (n = 3). Postoperative mortality and morbidity were nil. Adjuvant therapy included hepatic chemo-embolization and long-term therapy by a long-acting somatostatin analog. Five patients died during the period of follow-up and 4 patients were alive at the end of the study. Resection of small bowel carcinoid tumor is indicated even when the liver is involved by diffuse metastases to prevent the risk of small bowel occlusion, and to promote hepatic chemoembolization as subsequent therapy against the carcinoid syndrome and metastatic spread. Moreover, the procedure can participate in the selection of cases for orthotopic liver transplantation, when conservative therapy fails to control the carcinoid syndrome.
作者报告了他们切除伴有弥漫性肝转移的小肠类癌肿瘤的经验。在过去十年中，对9例患者进行了手术。每例患者生物学上均存在类癌综合征，8例有临床症状。每例患者的肿瘤均被切除，其中6例行右半结肠切除术，3例行小肠切除术。术后死亡率和发病率均为零。辅助治疗包括肝动脉化疗栓塞和长效生长抑素类似物的长期治疗。5例患者在随访期间死亡，4例患者在研究结束时仍存活。即使肝脏出现弥漫性转移，也应切除小肠类癌肿瘤，以防止小肠梗阻的风险，并促进肝动脉化疗栓塞作为后续治疗类癌综合征和转移扩散的手段。此外，当保守治疗无法控制类癌综合征时，该手术可参与原位肝移植病例的选择。
