几种常见胰腺神经内分泌肿瘤外科治疗方法选择及评价

Surgical management choice and evaluation on pancreatic endocrine tumor

胰腺神经内分泌肿瘤(pNENs)是胰腺外科常见的肿瘤之一,根据有无激素引起内分泌紊乱分为功能性和非功能性,常见的种类为胰岛素瘤、胃泌素瘤、无功能性pNENs等,不同种类肿瘤良恶性比例不同,部分恶性肿瘤可发生肝转移。外科治疗是pNENs的最主要的治疗手段,部分病人可通过手术治愈。不同肿瘤其外科处理的方式不尽相同,具体的手术方式取决于肿瘤类型、大小、肿瘤的位置、肿瘤侵犯的范围等,有肿瘤摘除术、胰十二指肠切除术、胰体尾切除术、胰腺节段切除术、保留十二指肠的胰头切除术等,部分肿瘤适合腹腔镜手术。与胰腺导管腺癌相比,其预后较好,即使发生肝转移,亦可争取手术切除原发肿瘤和肝脏转移灶,改善病人预后。

Abstract Pancreatic neuroendocrine tumor is one of the com- mon tumors in pancreatic surgery. According to the endocrinic disorder caused by the hormone secretion, it is divided into functional and non-functional tumors, such as insulinoma, gas- trinoma, non-functioning pancreatic neuroendocrine tumor. The ratio of benign to malignancy varies with the forms of tu- mors. Hepatic metastasis happens in partial tumors. Surgical management is the most important treatment method, which can cure partial patients. The surgical management method varies with different tumor forms. The specific surgery depends on the tumor form, size, position, the scope of tumor invasion, etc. which includes tumor enucleation, pancreatoduodenectomy, distal pancreatectomy, pancreaticsegmental resection, duodenum-preserving resection of pancreatic head and so on. Laparoscopy is suitable for partial tumors. The prognosis of pancreatic neuroendocrine tumor is much better compared with that of pancreatic ductal adenocarcinoma. Surgery should be positively considered to remove the primary and metastatic tumors to improve the prognosis of patients even with hepatic metastasis.