胃泌素瘤17例的诊断与治疗报告

The clinical aspects of gastrinoma: report of 17 cases

目的 探讨胃泌素瘤的诊断治疗经验。方法 对本院 1978年 1月至 1998年 5月收治的 17例胃泌素瘤资料进行回顾性研究。结果 17例中 3例为多发内分泌腺瘤Ⅰ型 (MENⅠ )。肿瘤分布广泛 ,其中胰腺内 31% (5 / 16 )、十二指肠内 2 5 % (4/ 16 )、淋巴结内 19% (3/ 16 ) ,其他部位2 5 % (4/ 16 )。B型超声、CT对肝脏和胰腺内病灶敏感性较高 ,但对十二指肠及淋巴结内较小的病灶检出率低 ,对此可进一步采用血管造影、经皮经肝门脉胃泌素测定、核素显影等检查。17例中 16例共行手术治疗 38次。多次手术占 5 6 %。全胃切除 7例 (7/ 17,41% )。 15例平均随诊 6年 5个月 ,5年生存率 87% (13/ 15 )。结论 提高本病的早期诊断 ,争取肿瘤切除和减少肝脏转移是改善预后的关键。

Objective[WT5”BZ] To sum up the experience of diagnosis and treatment for gastrinoma.[WT5”HZ] Methods[WT5”BZ] A retrospective study of 17 patients with gastrinoma admitted from 1978 through 1998 in PUMCH was performed.[WT5”HZ]Results[WT5”BZ] 3 of the 17 cases were associated with MEN I syndrome. Tumors dispersed extensively in pancreas in 31%(5/16),in duodenum in 25%(4/16),in lymph node in 19%(3/16) and in other sites in 25% (4/16).Ultrasonography and CT were sensitive in localizing tumor in pancreas and liver,but were not so well in localizing small tumor in duodenum and lymph node,at that time,angiography,percutaneous transhepatic portal sampling(PTPS),scintigraphy and endoscopic ultrasonography were introduced. 16 of 17 patients underwent 38 sessions of surgery and 56 percent of the 16 cases underwent multiple laparotomies. 7 patients at last received total gastrectomy.An average of 6.4 years follow up wittnessed a 5 year survival rate of 87%(13/15).[WT5”HZ] Conclusion[WT5”BZ] Diagnosing gastrinoma in its early stage, striving for the tumor resection and reducing liver metastasis were the cruxes for good prognosis for patients of gastrinoma. [WT5”HZ]