中醫治療胃神經內分泌瘤術後病例報告

Traditional Chinese Medicine in the treatment of postoperative gastric neuroendocrine tumors–A Case Report

神經內分泌瘤（neuroendocrine tumor）簡稱為NET，這種腫瘤會出現在有神經內分泌系統的器官，過度增生具有神經內分泌分化的上皮細胞，除了腫瘤本身造成身體傷害，還會出現內分泌過量的負荷，最常發生在消化系統中，例如胃腸神經內分泌瘤（gastrointestinal neuroendocrine tumors,簡稱GI-NETs）及胰臟神經內分泌瘤（Pancreatic Neuroendocrine Tumors，簡稱PNETs）。症狀的特異性低，常被誤認是其他病症，所以診斷也有難處，現有診斷工具為測量24小時尿中的5-氫氧靛基醋酸（5-Hydroxyindoleacetic acid,簡稱5-HIAA）、血清嗜鉻粒蛋白A（Chromogranin A,簡稱CgA）、影像、內視鏡檢查及放射性標記體抑素類似物成像。治療方式包括開刀手術、放射線治療、化學藥物療法、荷爾蒙治療和標靶治療。本案例是一名64歲女性，民國106年3月4日時檢查出第一型胃神經瘤，同年7月5日轉診於臺北榮民總醫院進行胃部分切除手術，患者自述此後持續胃悶脹感反覆，伴隨胃酸泛逆不適與打嗝，並且容易腹瀉、疲倦感與睡眠障礙等，投以西藥症狀治療效果不佳，胃泌素（Gastrin）仍高過於正常值。患者於110年10月25日前來臺北榮民總醫院傳統醫學部癌症門診就診，持續服中藥後，症狀明顯改善，胃泌素下降許多。

Neuroendocrine tumors (NET) are epidermal cell tumors with neuroendocrine differentiation that most commonly occur in the digestive system. Neuroendocrine tumors are divided into gastrointestinal neuroendocrine tumors, gastrointestinal NET (GI-NET) and pancreatic NET. GI-NET was formerly known as carcinoid, and the main symptoms are those associated with carcinoid syndrome. Symptoms are less specific and often mistaken for other conditions. The available diagnostic methods are measurement of 24-hour urine 5-hydroxy indoleacetic acid (5-HIAA), serum Chromogranin A (CgA), imaging, endoscopy, and radioactivity Imaging of labelled somatostatin analogs. Treatment is based on tumor size, degree of cell differentiation, activity, and whether liver metastases are present. This case is a 64-year-old female who was diagnosed with type I gastrointestinal neuroendocrine tumor on March 4, 2006. She was referred to Taipei Veterans General Hospital for partial gastrectomy on 5 July the same year. The feeling of bloating is repeated, accompanied by acid reflux and hiccups, and the patient also suffers from diarrhea, fatigue and sleep disturbance. The symptomatic treatment effect of western medicine is not good, and the gastrin level is still higher than the normal value. The patient came to the Department of Cancer Clinic of the Traditional Medicine of Taipei Veterans General Hospital on October 25, 110. After taking the traditional Chinese medicine continuously, the symptoms recovered significantly and the gastrin decreased a lot.