胰高糖素瘤的诊治

Diagnosis and treatment of glucagonoma in China

目的回顾性分析国内文献报告的胰高糖素瘤病例,总结其在我国的流行病学资料、临床表现、定性定位诊断及治疗。方法应用中国医学科学院医学信息研究所的“中国生物医学文献数据库”光盘(1981.1-2004.5),检索出20年国内报道的胰高糖素瘤文献,依据纳入标准,得到有效文献28篇,共34例,按肿瘤大小、部位、良恶性、胰外转移、临床表现、影象学检查、治疗方法、术式、转归等项目进行分析。结果34例中,男22例,女12例,平均年龄47.6岁,肿瘤单发33例,多发1例,30例位于胰体尾部,4例位于胰头颈部,平均直径5.23cm,恶性占82.8%,良性占17.2%,23例伴胰外转移,坏死性游走性红斑、糖尿病、口角炎、贫血、消瘦是最常见的症状,血浆氨基酸谱分析有助于诊断,B超、CT等影像学检查阳性率较高,手术是最常用的治疗方法,本组治愈率为56%。结论胰高糖素瘤是罕见疾病,恶性居多,临床表现易与湿疹、糖尿病等混淆,致长期误诊,仔细分析配合理化检查可以定性诊断;提高对本病的认识,作到早期诊断、早期手术,可望提高治愈率,改善预后。

Objective To summarize the clinical data of glucagonoma reported in Chinese periodicals. Methods The Chinese articles on glucagonoma were screened from The Chinese Bio-Medical Disc （1981.1-2004.5）. The size, symptoms, position, benign ＆malignancy, metastasis, image ex amination and treatment procedures of the tumors were reviewed. Results 28 pieces of articles and 34 cases of glucagonoma were found. Of 34 cases, there were 22 male and 12 female with an average age of 47.6 years old. 33 had solitary lesion, 1 had multiple lesions. The tumors of 30 cases were located in the body or tail, and 4 cases was in the head＆neck of the pancreas. The average diameter of the lesions was 5.23 cm. 82.8% of all the cases were malignant and 17. 2% Were benign. The common symptoms were the necrolytic migratory erythema （NME）, diabetes, anemia, weight loss, and stomatitis. CT and BUS were quite accurate and sensitive for localizing this tumor. The only chance for treatment of glucagonoma was surgical resection. Conclusions Glucagonoma is a rare pancreatic endocrine tumor, and most of them are malignant. The skin rash and diabetes are the characteristics of glucagonoma. Earlier diagnosis and surgical resection of the tumor should be emphasized.