胰腺内分泌肿瘤的外科治疗

Surgical treatment of pancreatic endocrine tumors

目的提高对胰腺内分泌肿瘤的认知和诊疗水平。方法回顾性分析1968-2005年收治的78例胰腺内分泌肿瘤患者的临床资料。结果胰岛素瘤49例,均为良性,其中40例行单纯肿瘤摘除术(2例在腹腔镜下完成),2例在摘除的同时行胰腺空肠Roux-en-Y吻合术,7例行胰体尾切除术;胰高血糖素瘤4例,均有肝转移,行原发病灶及部分转移灶切除术;胰多肽瘤21例,恶性8例,手术切除16例,其余5例因肿瘤无法切除而放弃手术;舒血管肠肽瘤1例和胰腺类癌3例,均为恶性,行外科手术。术后均获得满意的疗效。结论手术切除是胰腺内分泌肿瘤最为理想的治疗方法。术前定性诊断尤为重要,关键是提高对这类肿瘤的认知水平。对胰岛素瘤不强求术前定位诊断,应慎用有创性诊断方法,术中胰腺探查是定位的关键。其他内分泌肿瘤术前多可依影像学检查定位诊断。手术方式根据肿瘤生长部位而定。姑息性切除手术亦可明显缓解症状。即便是恶性肿瘤,其预后亦明显好于胰腺外分泌肿瘤。

Objective To get a better understanding of pancreatic endocrine tumors（PETs） so as to improve the level of their diagnosis and treatment. Methods The clinical data of seventy-eight cases of PETs, who were admitted to our department from 1968 to 2005, was retrospectively analyzed in this study. Results All the forty-nine cases of insulinoma were confirmed to be benign. Tumor enucleation was performed in 40 cases. Tumor enucleation and additional pancreas-jejunum Roux-en-Y anastomosis were performed in two cases. Seven patients received distal pancreatectomy. Four glucagonoma treated by palliative resection of the primary focus and partial liver metastasis. In twenty one patients with polypeptide tumor of the pancreas, eight cases were proved malignant. Sixteen cases received surgical resection and the rest have to give up resection, short of surgical condition. In addition, the surgical treatment was performed in one patient with malignant tumor of vasoactive intestinal peptide （VIP） and 3 patients with pancreatic carcinoid tumors. The good prognosis had been achieved in a major of cases after surgical treatment. Conclusions The best choice to treatment of pancreatic endocrine tumor is to resect mass completely. Pre-operative qualitative diagnosis should be emphasized. To insulinoma, localization diagnosis doesn＇t insist on if difficult and depend fully on traumatic diagnosis means. In operation the careful palpation always helps to find accurately the place of insulimoma. Other PETs often can be located by imaging examination. The surgical manners were decided by position and biological character of tumors. The symptoms could be relieved by palliative procedures. The prognosis of malignant endocrine tumors was further better than that of the pancreatic exocrine tumors.