Wareing T H, Sawyers J L
Am J Surg. 1983 Jun;145(6):769-72. doi: 10.1016/0002-9610(83)90136-8.
The many manifestations of carcinoids will continue to puzzle and intrigue surgeons. Because these are dynamic tumors which produce multiple hormones with many potential side effects, an aggressive surgical debulking of them is advocated. Even in the presence of metastatic disease, some long-term survival can be anticipated. The most debillitating aspect of this tumor to the patient is the carcinoid syndrome. The symptoms occur erratically and are often not well controlled by presently available medication. Although metastatic disease present at diagnosis is most commonly seen with jejunoileal carcinoids, colorectal carcinoids appear to be the most lethal tumors. However, they are rarely associated with the symptoms of carcinoid syndrome. Carcinoids may often be associated with other types of tumors, some of which are known to produce their own hormones. Survival of the patients seems to be related to their other tumor type rather than the primary carcinoid. The clinician should be aware of the strong association of carcinoids with peptic ulcer disease. The ulcer diathesis is probably related to ectopic histamine production and can usually be controlled by cimetidine and antacids, although surgical intervention may be required.
类癌的多种表现将继续困扰并吸引外科医生。由于这些是动态肿瘤，会产生多种具有许多潜在副作用的激素，因此主张积极进行手术减瘤。即使存在转移性疾病，也可预期有一定的长期生存率。该肿瘤对患者最具致残性的方面是类癌综合征。症状发作不规律，目前可用的药物往往难以有效控制。虽然诊断时出现的转移性疾病最常见于空肠回肠类癌，但结直肠类癌似乎是最致命的肿瘤。然而，它们很少与类癌综合征的症状相关。类癌常可能与其他类型的肿瘤相关，其中一些已知会产生自身的激素。患者的生存似乎与其其他肿瘤类型有关，而非原发性类癌。临床医生应意识到类癌与消化性溃疡病之间的密切关联。溃疡素质可能与异位组胺产生有关，通常可用西咪替丁和抗酸剂控制，不过可能需要手术干预。
