胰腺神经内分泌肿瘤伴肝转移诊断及治疗(附16例报告)  

Clinical comprehensive treatment of pancreatic neuroendocrine neoplasm with liver metastases:a study of 16 cases

作　　者：许雪峰[1] 韩序[1] 施晨晔[1] 方圆[1] 纪元[2] 邵叶波[1] 靳大勇[1] 楼文晖[1] 

机构地区：[1]复旦大学附属中山医院普外科复旦大学普通外科研究所,上海200032 [2]复旦大学附属中山医院病理科,上海200032

出　　处：《中国实用外科杂志》2012年第9期775-777,共3页Chinese Journal of Practical Surgery

摘　　要：目的探讨胰腺神经内分泌肿瘤伴肝转移的生物学特征及临床特点、组织学特点、治疗方法及预后。方法回顾性分析复旦大学附属中山医院1999年1月至2011年6月收治的16例胰腺神经内分泌肿瘤伴同时性和异时性肝转移病例的临床资料。结果 16例中男5例,女11例。平均年龄48岁。肿瘤位于胰头5例,胰体5例,胰尾6例。行胰十二指肠切除术5例,其中1例因术后出现肝转移再次手术行转移灶切除。行胰体尾和脾切除术7例,其中2例同时行肝转移灶切除。3例行胰腺部分切除术,其中2例同时行肝转移灶切除。1例行穿刺活检术。16例中同时性肝转移11例,5例为异时性肝转移,15例为多发性肝转移。10例术后行介入、射频消融、生长抑素和化疗。病理检查:瘤体平均7.74cm×6.56cm×5.02cm。6例有淋巴结转移,11例侵犯神经,1例侵犯十二指肠、胆总管。结论对于胰腺神经内分泌肿瘤伴肝转移病例应制定合理、积极有效的综合治疗方案,对提高临床治愈率、改善病人预后具有重要的意义。Objective To investigate the histological features, biological features,clinical treatment and prognosis of pancreatic neuroendocrine neoplasm with liver metastases. Methods A retrospective review of 16 patients with pancreatic neuroendocrine neoplasm with simultaneous and metachrouous liver metastases treated in our hospital during a 12-year period was adopted. Results Pancreatic neuroendocrine neoplasm with liver metastases was found in 5 men and 11 women with a mean age of 48 years.Tumor located in the head of pancreas in 5 cases, body and tail in 11 cases. Of the 16 patients, 5 received pancreaticoduodeneetomy, One cases who underwent liver metastases resection 22 months after surgery.7 received distal pancreatectomy, 3 received partial pancreatectomy, two cases of combined liver metastases resection simultaneously, 1 received only biopsy. Simuhaneous liver metastases in 11 cases, five cases of metachronous liver metastases. 15 cases of patients with multiple liver metastases. Ten patients received postoperatively intervention, radiofrequency ablation, somatostatin and chemotherapy. Histologically all tumors were average 7.74 cmx6.56 cmx5.02 cm in size. Neural invasion was present in 11 cases. Lymphatic invasion was noted in 6 cases. Three patients lost to follow-up and three patients died from tumor recurrence or recurrence-related complications. Conclusions Pancreatic neuroendocrine neoplasm with liver metastasis cases should be to develop a reasonable, positive and effective treatment programs to improve the clinical cure rate and improve the prognosis.

关 键 词：胰腺 神经内分泌肿瘤 肝转移 

分 类 号：R6[医药卫生—外科学]