功能性胰岛细胞瘤术中精准定位与切除  

Precise positioning and enucleation for the treatment offunctional islet cell tumor

作　　者：徐新建[1] 李建刚[1] 耿诚[1] 宋涛 林海[1] 王喜艳[3] 

机构地区：[1]新疆医科大学第一附属医院胰腺外科,乌鲁木齐830054 [2]影像中心 [3]新疆医科大学附属肿瘤医院,乌鲁木齐830011

出　　处：《中华消化外科杂志》2013年第8期624-626,共3页Chinese Journal of Digestive Surgery

基　　金：新疆维吾尔自治区科技支疆项目（201291170）

摘　　要：目的探讨功能性胰岛细胞瘤术中B超引导下精准定位与切除的临床应用价值。方法回顾性分析2005年1月至2011年12月新疆医科大学第一附属医院收治的20例功能性胰岛细胞瘤患者的临床资料，总结其精确定位诊断方法、精准手术方式及预后情况。结果21例患者术前行CT、MRI、腹部B超检查定位诊断阳性率分别为12／18、2／6、7／13，诊断的肿瘤直径分别为（1．7±0．8）cm、（1．3±0．2）cm、（1．9±0．9）cm；选择性动脉钙刺激静脉采血检查11例、胰腺灌注CT定位检查2例，定位诊断均为阳性，两种方法检测肿瘤直径分别为（0．7±0．3）cm和（0．9±0．4）cm。患者术中行B超检查阳性率为14／14，肿瘤直径为（1．5±0．6）cm。功能性胰岛细胞瘤采用常规手术6例，术后发生C级胰瘘2例、A级胰瘘1例；功能性胰岛细胞瘤采用精准切除术14例，术后发生A级胰瘘4例。20例患者均获得随访，截至2012年4月，患者一般情况良好，无死亡、恶变、转移或复发等情况发生。结论术前和术中多种定位方法结合能对功能性胰岛细胞瘤精确定位，对于病灶距离主胰管〉3mm的患者建议采用胰岛细胞瘤的精准切除术。Objective To investigate the clinical value of intraoperative ultrasound guided precise positioning and enucleation of the functional islet cell tumor. Methods The clinical data of 20 patients with functional islet cell tumor who were admitted to the First Affiliated Hospital of Xinjiang Medical University from lauuary 2005 to December 2011 were retrospec- tively analyzed. The method of precise positioning, surgical approach and prognosis of the patients were reviewed. Results The accurate rates of computed tomography （CT）, magnetic resonance imaging （MRI） and transabdominal B ultrasound indetecting the position of the functional islet cell tumors were 12/18, 2/6 and 7/13, respectively, and the diameters of the tumors were （1.7 ±0.8）cm, （1.3 ±0.2）cm and （1.9 ±0.9）cm, respectively. The accurate rates of arterial stimulation venous sampling and pancreatic perfusion CT imaging were 100% , and the diameters of the tumor detected were （0.7 ± 0.3 ） cm and （0.9 ± 0.4） cm. The accurate rate of intraoperative B uhrasound examination was 14/14, and the diameter of the tumor was （ 1.5 ± 0.6） cm. Routine surgery was carried out on 6 patients, and 2 patients were complicated with grade C pancreatic fistula, and 1 was complicated with grade A pancreatic fistula. Fourteen patients received precise enucleation of islet cell tumor, and 4 patients were complicated with grade A pancreatic fistula. Twen- ty patients were followed up. The general condition of the pa- tients was good till April 2012, and no death, tumor recurrence and metastasis were detected. Conclusions Combination of pre- and intraoperative imaging positioning could precisely locate functional islet cell tumor. If the distance between the tumor and main pancreatic duct is above 3 mm, precise enucleation of the islet cell tumor should be considered.

关 键 词：功能性胰岛细胞瘤 诊断 治疗 

分 类 号：R736.7[医药卫生—肿瘤]