胰腺内分泌肿瘤的外科治疗

Surgical treatment of pancreatic endocrine tumors

目的探讨胰腺内分泌肿瘤的临床特点和外科治疗方法。方法对收治的胰腺内分泌肿瘤33例患者的临床资料进行回顾性。结果 33例中胰岛素瘤18例,无功能性胰岛细胞瘤9例,胃泌素瘤4例,胰高血糖素瘤2例。其中29例进行根治行切除,4例因肿瘤无法切除而放弃手术,总手术切除率为87.8%,术后发生胰瘘5例,肠梗阻2例,无住院期间死亡病例。26例平均随访时间为(4.7±3.5)年(9个月至14年),其中恶性14例患者总的1年和3年生存率为71.4%和50.0%,在随访期间19例良性患者全部存活。结论手术切除是胰腺内分泌肿瘤最为理想的治疗方法。术前定性及术中定位尤为重要,术中胰腺探查结合术中B超是定位的关键。选择合适的术式有助于避免术后并发症的发生。

Objective To analyze the clinical features and appropriate surgical treatment methods of pancreatic endocrine tumors. Methods The clinical data of 33 cases of pancreatic endocrine tumors treated in our hospital during February 1989 to February 2008 were retrospectively anslyzed. Results There were 18 cases of insulinoma,9 of nonfunctional islet cell tumor,4 of gastrinoma and 2 of glucagonoma.In a total of 33 cases,29 patients underwent radical resection,and 4 patients with unresectable tumors did not undergo resection.The overall resection rate was 87.8%,with postoperative complications of pancreatic leakages in 5 cases and intestionol obstruction in 2 cases.There were no hospital deaths.The mean follow-up of 26 pationts was（4.7±3.5） years（9 months to 14 years）.The 1-and 3-year survival rate of 14 malignant cases was 71.4% and 50.0%,respectively;all of the 19 patients with benign tumors survived. Conclusions The best choice for treatment of pancreatic endocrine tumors is complete surgical resection.Pre-operative localization diagnosis of the tumor should be emphasized.At operation,careful palpation and ultrasonography is the key to accurately locate the tumor.The choice of proper operative procedure can help to avoid the occurrence of complications.