胰腺内分泌肿瘤的诊断和外科治疗  

Diagnosis and surgical treatment of pancreatic endocrine tumors

作　　者：汪洁[1] 蔡端[1] 张延龄[1] 

机构地区：[1]复旦大学附属华山医院普外科,上海200040

出　　处：《外科理论与实践》2008年第1期61-64,共4页Journal of Surgery Concepts & Practice

摘　　要：目的:复习胰腺内分泌肿瘤的临床表现和诊治过程,以熟悉对这些罕见肿瘤的认识。方法:收集我科33年来(1973年1月至2006年12月)的77例胰腺内分泌肿瘤病人资料,进行回顾性分析。结果:本组包括胰岛素瘤43例(55.8%);胃泌素瘤7例,其中2例合并甲状旁腺瘤(为多发性內分泌瘤第Ⅰ型);胰高血糖素瘤5例;血管活性肠肽瘤1例;非功能胰岛细胞瘤21例(27.3%)。女性占59.7%;良、恶性分别占81.8%和18.2%。77例均行B超和CT检查,发现其中84.4%胰腺有占位病变,但定性检查乃依赖于术后病理切片检查;均行手术,发现肿瘤位于胰头、体、尾部者分别占18.2%、26.0%、45.5%,8例为多发肿瘤。对5类胰腺内分泌肿瘤的临床表现和治疗方案均给予介绍,脾胰体尾切除术、肿瘤局部切除术和胰头十二指肠切除术是主要的手术方式。结论:熟悉不同胰腺内分泌肿瘤的特异症状,并辅以生化检查、B超和CT扫描,可及时辨认罕见肿瘤。手术切除是其主要的治疗方法,选择合适的术式有助于避免术后并发症的发生和改善预后。Objective To review the clinical pictures and therapeutic programs of pancreatic endocrine tumors （PETs）, in order to familiarize with these rarely encountered disease entities. Methods The clinical data from 77 cases of PETs, admitted in the past 33 years（Jan 1973 to Dec 2006）, were retrospectively analyzed. Results In a total of 77 cases, there were 43 cases of insulinomas （55,8%）, 7 gastrinomas （including 2 cases of MEN-1 associated with parathyroid adenoma）, 5 glucagonomas, 1 vipoma and 21 nonfunctional islet cell tumors. The incidence was higher in female patients （59.7%）. Most cases were benign tumors（81.8%）. During operation, most tumors were found to be situated in the tail of the pancreas（45.5%）; 18.2% and 28.6% were located in the head and body of the pancreas retrospectivly. Eight cases of them were mutiple tumors. The clinical pictures and therapeutic procedures of 5 kinds of PETs were briefly described accordingly. All of them were examined by uhrasonography and CT scan and 84.4% of these cases were proved to be space-occupying lesions, whose nature was to be comfirmed by postoperative pathologic examination. Resection of the pancreatic tail with splenectomy, local excision of the tumor, and pancreatoduodenectomy were the three main operative procedures. Conclusions Cognizant of the characteristic clinical pictures of different pancreatic endocrine tumors, accompanied by blood biochemical analysis, uhrasonography and CT scanning, will he helpful in diagnosing these rarely encountered disease entities. Surgical excision is the preferable mode of treatment. The proper operative procedure （s） chosen help to avoid the occurrence of complications and improve the prognosis of PETs.

关 键 词：胰岛细胞瘤 诊断 外科手术 预后 

分 类 号：R735.9[医药卫生—肿瘤]