胰腺神经内分泌肿瘤外科治疗决策探讨(附60例分析)

Surgical treatment decision of patients with pancreatic neuroendocrine tumors:An analysis of 60 cases

目的探讨胰腺神经内分泌肿瘤(PNETs)的外科治疗决策。方法收集广东省人民医院2000年1月至2010年1月间收治的60例PNETs病人的临床病理学资料,对相关资料进行分析,探讨临床特点、手术方式与预后的关系。结果 60例PNETs中32例(53.3%)为功能性,28例(49%)为无功能性;G1、G2和G3级肿瘤分别占70%、15%、15%;发现淋巴结转移8例,肝转移8例;54例获得R0切除,6例行姑息性手术;单因素分析提示肿瘤大小、分级、淋巴结转移、肝转移是影响PNETs预后的主要因素。结论手术是PNETs的主要治疗手段,肿瘤大小、分级、淋巴结转移、肝转移是PNETs重要预后因素;直径<2 cm的PNETs手术指征需更多的临床研究支持,建议对除胰岛素瘤之外的其他PNETs常规行淋巴结清扫术。

Objective To identify the surgical treatment decision of pancreatic neuroendocrine tumors（PNETs）.Methods The clinical data of 60 cases of pancreatic neuroendocrine tumors admitted between January 2000 and January 2010 in Guangdong General Hospital were analized retrospectively.The correlations between prognosis and clinical characteristics,surgical method were studied.Results In 60 cases of PNETs,32 cases（53.3%） were functional,and 28 cases（46.7%） were non-functional.G1,G2 and G3 grade tumors were 70%,15%,15%respectively.There were8 cases of lymph node metastasis and 8 cases of liver metastasis.A total of 54 cases received R0 resection and 6 cases received palliative operation.The univeriate analysis indicated that tumor size,grade,lymph node metastasis and liver metastasis were the main influence factors for PNETs prognosis.Conclusion Surgery is still the main method to cure PNETs.Tumor size,grade,lymph node metastasis,liver metastasis are important factors for PNETs prognosis.More clinical research need to be done to support the surgical resection of PNETs with diameter less than 2cm.Furthermore,routine lymph node dissection should be done except for insulin tumor.