恶性胰腺神经内分泌肿瘤的外科手术选择

Surgical treatment strategy for malignant pancreatic neuroendocrine tumor

目的 探讨恶性胰腺神经内分泌肿瘤（PENTs）外科手术方式选择的策略.方法 收集2003年1月至2009年12月收治的32例恶性PENTs患者的临床资料,其中男性19例,女性13例,年龄17～71岁,平均46.3岁.回顾性分析恶性PENTs患者的手术方式选择及预后情况.结果 32例恶性PENTs中,功能性PENTs 12例、无功能性PENTs 20例.31例行手术治疗,其中4例行肿瘤局部切除,7例行Whipple手术,17例行胰体尾联合脾切除术,3例行剖腹探查肿瘤活检术.1例经CT引导下穿刺活检病理证实为恶性PNETs后行保守治疗.2例患者随访18和19个月后失访,5例患者在术后1年内死亡,3例患者分别在术后14、26、49个月后死亡,22例术后平均随访28个月（4～83个月）仍然存活.生存分析结果显示,1、2、5年生存率分别为83.5%、72.6%、54.4%.结论 恶性PENTs应积极行手术治疗.胰头恶性PENTs是否行局部切除以及肿瘤减瘤手术尚有待进一步探讨.

Objective To investigate the surgical options for the malignant pancreatic neuroendocrine tumor （PNETs）. Methods The clinic data of 32 patients with malignant pancreatic neuroendocrine tumors who were admitted between January 2003 and December 2009 were summarized. There were 19 male and 13 female,aging from 17 to 71 years（mean age,46. 3 years）. The general information,postoperative pathology results, surgical options and followup were also collected. Results There were 32 cases of malignant PNETs including functional malignant PNETs in 12 cases and nonfunctional malignant PNETs in 20 cases. Thirty-one patients accepted surgical treamtents which included local resections in 4 patients, Whipple procedures in 7 patients, distal pancreatectomy in 17 patients and laparotomy in 3 patients. One patient accepted CT guided biopsy. Follow up were lost in two patients after operations. Five patients died in the first year after operations. Twenty-two patients still survived after mean follow up of 28 months（4-83 months）. The survival rate for this group of patients was 83.5% in the first year,72. 6% in the second year and 54. 4% in the fifth year. Conclusions Malignant PNETs is the proper indication for surgical treatments. More accumulation of clinical data is needed to evaluate the significance of local resection of malignant PNETs in pancreatic head and cytoreductive surgery.