恶性胰岛细胞瘤23例诊治分析

Malignant islet cell tumor: A clinical analysis of 23 cases

目的探讨恶性胰岛细胞瘤的临床特点及诊治方法。方法回顾性分析我院1993-2012年收治的经手术或穿刺病理证实的恶性胰岛细胞瘤23例。结果其中恶性胰岛素瘤6例,平均直径2.1 cm,首发症状为Whipple三联征或低血糖昏迷,肿瘤均单发,位于胰体尾部,5例伴有肝脏转移,3例行手术治疗,术后低血糖症状均改善。恶性无功能胰岛细胞瘤17例,平均直径6.2 cm,首发症状为腹部包块、腹痛或无痛性黄疸,15例肿瘤单发,11例位于胰腺体尾部,10例有肝脏转移,12例手术,术后梗阻症状均有显著改善。23例术前均应用多种影像学方法定位。结论恶性胰岛细胞瘤主要包括恶性胰岛素瘤和恶性无功能胰岛细胞瘤,大多单发,位于胰腺体尾部,肝转移最常见;以手术为主的综合治疗可有效缓解低血糖及梗阻症状。

Objective To study the clinical characteristics,diagnosis and treatment of malignant islet cell tumor.Methods Twenty-three cases of surgery-or biopsy-confirmed malignant islet cell tumor admitted to our hospital from 1993 to 2012 were retrospectively analyzed.Results Of the 23 cases of malignant islet cell tumor,6 were diagnosed as insulinoma（average diameter 2.1 cm） with their first symptom manifested as Whipple triad or hypoglycemic coma.Single tumor was located in the pancreatic body or tail,5 were diagnosed as liver metastasis,and 3 underwent tumor resection with their hypoglycemia improved after operation.Of the 23 cases of malignant islet cell tumor,17 were diagnosed as malignant nonfunctioning islet cell tumor（average diameter 6.2 cm） with their first symptoms manifested as abdominal mass and abdominal pain or painless jaundice.The tumor was located in the pancreatic body or tail of 11 out of the 15 cases of single tumor,10 cases were diagnosed as liver metastasis and 12 cases underwent tumor resection with their symptoms relieved after operation.The tumor was located in the 23 cases using imaging methods.Conclusion Malignant islet cell tumors mainly include malignant insulinoma and malignant nonfunctioning islet cell tumor,most of which are singly and usually located in the pancreatic body or tail.Its most metastatic site is the liver.Combined treatment,especially surgery,can alleviate the symptoms of hypoglycemia and obstruction.