胰腺恶性内分泌肿瘤的诊断和治疗经验

Experience in diagnosis and treatment of malignant pancreatic endocrine tumor

目的总结胰腺恶性内分泌肿瘤的诊治经验。方法回顾性分析1969年1月至2008年12月南京医科大学第一附属医院收治的38例胰腺恶性内分泌肿瘤患者的临床资料。其中胰岛素瘤6例，胰多肽瘤23例，胰高血糖素瘤4例和胰腺类癌5例。结果除1例胰岛素瘤外，所有患者经术前影像学检查发现胰腺占位；手术切除率87％（33／38），病理学检查提示肝转移7例，淋巴结转移5例，血管、淋巴管发现瘤栓1例，局部浸润28例。术后随访24例，1例胰岛素瘤局部复发再次手术切除，1例胰腺类癌肝转移再次射频治疗，其余无转移、复发表现。结论影像学检查是胰腺内分泌肿瘤的主要诊断依据。其恶性程度应根据术前影像学表现、术中探查、术后病理检查并结合随访综合判定。恶性胰腺内分泌肿瘤恶性程度低，手术切除率高，预后良好。

Objective To investigate the clinical features, diagnosis and treatment of malignant pancreatic endocrine tumor. Methods The clinical data of 38 patients with malignant pancreatic endocrine tumor who had been admitted to First Affiliated Hospital of Nanjing Medical University from January 1969 to December 2008 were analyzed retrospectively. Of all patients, 6 were with insulinoma, 23 with pancreatic polypeptide tumor, 4 with glucagonoma and 5 with pancreatic earclnoid. Results All patients except 1 with insulinoma were found with pancreatic lesion by imaging examination. The resection rate was 87% （33/38）. Pathological examination found 7 patients with liver metastasis, 5 with lymph node metastasis, 1 with tumor thrombus in vessels and lymphatic vessels, and 28 with local invasion. Twenty-four patients were followed up, and neither recurrence nor metastasis was found except 1 patient with insulinoma who received reoperation for local recurrence and 1 patient with pancreatic carcinoid who received radiofrequency ablation for liver metastasis. Conclusions The diagnosis of pancreatic endocrine tumor mainly depends on imaging examination. The malignancy of pancreatic endocrine tumor is determined after the comprehensive analysis of preoperative imaging findings, intraoperative examination, post- operative pathological examination and the data obtained during follow-up. The malignant pancreatic endocrine tumor should be managed actively by resection because of its relatively low malignancy, high operative resectability and relatively good prognosis.