[原发性恶性小肠肿瘤]

[Primary malignant small bowel tumors].

作者信息

Zonča P, Peteja M, Richter V, Vávra P, Ihnát P

出版信息

Rozhl Chir. 2016 Fall;95(9):344-349.

Abstract

INTRODUCTION

Small bowel presents 75% of the gut length and 90% of the gut surface. However, primary malignant tumors of the small bowel represent only 1-3% of all malignant gastrointestinal tumors. The aim of the present paper is to offer a current review of primary malignant small bowel tumors - their epidemiology, localization, symptoms, diagnostic and treatment options.

METHODS

The authors have performed a comprehensive review of databases Medline, Scopus and Google Scholar focusing on studies regarding small bowel cancer.

RESULTS

The most frequent small bowel tumors are adenocarcinoma (30-40%), neuroendocrine tumors (35-44%), lymphomas (10-20%) and gastrointestinal stromal tumors (12-18%). Symptomatology is non-specific and varies widely, which is why small bowel cancer is usually diagnosed in a locally advanced stage of the disease. Diagnosis is determined through standard methods (gastroscopy, colonoscopy, CT) and complementary special diagnostic modalities (capsule enteroscopy, enteroscopy, octreotide scan, etc.). Diagnostic process with a negative outcome frequently leads to diagnostic laparoscopy/laparotomy.The treatment of small bowel cancer in patients operated in acute settings is done according to acute abdomen management guidelines. Elective surgery of small bowel cancer differs with respect to the tumor type. Adenocarcinomas and neuroendocrine tumors should be treated with surgical R0 resection with radical lymphadenectomy (and multivisceral resection if necessary). Patients with GIST should undergo en bloc resection with 2-3cm safety resection margins (lymphadenectomy is not necessary). Palliative resection of neuroendocrine tumors can be associated with a significant clinical effect. On the other hand, palliative resection of adenocarcinomas of GIST is not advocated.

CONCLUSION

Small bowel cancer is an infrequent condition. Symptoms are non-specific; patients are often diagnosed in an advanced stage of the disease. Achieving R0 surgical resection is usually difficult due to locally advanced stage of the disease. Besides the tumor type, patients prognosis is influenced by very late diagnosis of the tumor.

KEY WORDS

primary tumor - small intestine - diagnostics - treatment options - surgical resection.

摘要

引言

小肠占肠道长度的75%，肠道表面积的90%。然而，小肠原发性恶性肿瘤仅占所有胃肠道恶性肿瘤的1% - 3%。本文旨在对原发性小肠恶性肿瘤进行当前综述——包括其流行病学、定位、症状、诊断和治疗选择。

方法

作者对Medline、Scopus和谷歌学术数据库进行了全面综述，重点关注有关小肠癌的研究。

结果

最常见的小肠肿瘤是腺癌（30% - 40%）、神经内分泌肿瘤（35% - 44%）、淋巴瘤（10% - 20%）和胃肠道间质瘤（12% - 18%）。症状不具特异性且差异很大，这就是为什么小肠癌通常在疾病的局部晚期才被诊断出来。诊断通过标准方法（胃镜、结肠镜、CT）和辅助特殊诊断方式（胶囊内镜、小肠镜、奥曲肽扫描等）来确定。诊断结果为阴性的诊断过程常常导致诊断性腹腔镜检查/剖腹手术。急性情况下接受手术的小肠癌患者的治疗按照急腹症处理指南进行。小肠癌的择期手术因肿瘤类型而异。腺癌和神经内分泌肿瘤应采用R0手术切除并进行根治性淋巴结清扫（必要时进行多脏器切除）。胃肠道间质瘤患者应进行整块切除，切缘有2 - 3厘米的安全切除范围（无需进行淋巴结清扫）。神经内分泌肿瘤的姑息性切除可产生显著的临床效果。另一方面，不主张对腺癌或胃肠道间质瘤进行姑息性切除。