胰血管活性肠肽瘤1例报告并国内文献复习  

Diagnosis and treatment of vasoactive intestinal peptide tumors:one case report and literature review in China

作　　者：王科伟[1] 张佳林[2] 田雨霖[1] 刘树荣[2] 李昱骥[1] 周建平[1] 孔凡民[1] 董明[1] 

机构地区：[1]中国医科大学附属第一医院普通外科教研室胃肠外科,辽宁沈阳110001 [2]中国医科大学附属第一医院普通外科教研室肝胆外科,辽宁沈阳110001

出　　处：《中国实用外科杂志》2010年第9期773-776,共4页Chinese Journal of Practical Surgery

摘　　要：目的探讨胰血管活性肠肽瘤(VIPoma)诊断和治疗方法。方法报告中国医科大学附属第一医院2010年2月收治1例VIPoma的临床资料,并检索国内1993年1月至2009年12月间文献报道的24例。对25例VIPoma临床表现、实验室检查、影像学检查、手术方式及随访资料进行分析。结果有记载的24例中22例有周期性发作的水样泻;22例检测血清钾,21例有低钾血症。13例血浆血管活性肠肽(vasoactive intestinal peptide,VIP)测定均高于正常。行B超检查15例中13例发现病变,10例病变于胰腺内。行CT检查22例中18例胰腺内发现病变,其中7例发现肝脏转移性病灶。25例中24例行手术治疗,行胰体尾切除术13例中11例术前有水样泻,术后7例水样泻消失,1例好转,另3例无记载。行肿瘤摘除术3例中1例术后水样泻消失,1例明显好转。1例胰头部VIPoma并发肝转移,行扩大的胰十二指肠切除术后水样泻消失。行胰体尾切除术13例,获得远期随访8例,随访3个月至3.5年,1例术后3个月大出血死亡,1例术后3.5年复发、肝转移,另6例无复发。结论 VIPoma诊断依赖于典型的临床症状和血浆VIP测定;B超及CT是胰腺VIPoma定位诊断的可靠方法。手术切除为胰腺VIPoma有效治疗手段,即使是姑息性切除亦可改善病人生活质量,延长存活时间。Objective this paper summarizes the clinical data of twenty five patients of VIPoma to explore the methods of diagnosis and treatment of the VIPoma. Methods there has been one VIPoma patient received and cured in our hospital in 2010, February and the author searched other twenty four patients from literature documents from January of 1993 to December of 2009. And then this paper makes analysis according to these 25 clinical expressions, laboratory examinations, image detection ,the methods of operation and the follow-up data. Results there were 22 out of the 24 examples developing watery diarrhea documented happened periodically;22 cases＇ serum potassium had been detected, and among them, 21 cases have the hypokalemia. 13 cases＇ blood plasma VIP measuered higher than normal.CT checked 22 cases and 18 ones of them had lisions, and 7 ones had liver metastasis. Among the 25 cases, 24 cases had accepted surgical treatment. In the 13 resections of the tail of the pancreas, 8 ones got long-term follow-up visits, for 3～3.5 years： one case died because of the massive haemorrhage, one case had the recurrence and hepatic metastases after 3.5 years, but the other 6 cases didn＇t have the recurrences. Conclusion the diagnosis of VIPoma relies on typical clinical symptoms and bloodplasma VIP measurement;B-type ultrasonic and CT are the reliable diagnosis methods of VIPoma .Surgical excision is an effective treatment of the VIPoma, even the palliative resection also can improve the quality of life of patients and prolong their life.

关 键 词：胰腺 血管活性肠肽瘤 胰岛细胞瘤 

分 类 号：R6[医药卫生—外科学]