胰腺神经内分泌肿瘤外科治疗的最新研究进展

Recent advance in surgical treatment of pancreatic neuroendocrine tumors

胰腺神经内分泌肿瘤（pancreatic neuroendocrine tumors，P—NETs）是一组异质性肿瘤，包括功能性和非功能性两大类。近年来，由于对该疾病认识的不断深入及各种影像学检查的不断进步，P．NETs的诊断率明显增高。以有丝分裂数和Ki．67阳性指数为基础的分级方案对P—NETs的诊治及预后有重要意义。P—NETs是一组生物学行为较为惰性的恶性肿瘤，其手术可切除率及远期疗效明显好于胰腺导管腺癌。P—NETs恶性潜能不～致，临床医生需结合患者的症状、肿瘤的分级分化和TNM分期等信息制定综合的治疗方案。手术目前仍是治愈P—NETs的唯一有效方式．即使不能实施根治性切除，姑息性手术也能明显缓解患者的临床症状，甚至延长其生存时间。通常根据肿瘤的部位、大小、数量、分化程度及有无局部侵润和远处转移等因素选择不同的手术方式。

Pancreatic neuroendocrine tumors （P-NETs） are a group of heterogeneous tumors, including functional and nonfunctional ones. With the enhancement of clinicians＇ awareness about this disease and the im- provement of imaging diagnostic techniques, the incidence of P-NETs has obviously increased in the past years. Based on the mitotic counting and Ki-67 positive index, the grading classification is of great value for the diagnosis, treatment and even prognosis of P-NETs. P-NETs are a group of malignant tumors with inert biological behaviors, whose surgical resection rate and long-term survival is much better than those of pancreatic ductal ade- nocarcinoma. P-NETs have different malignant potentials. Clinicians need to develop a comprehensive treatment plan in combination with the patient＇s symptoms, tumor grading classification and TNM staging information. Surgery is the only curable way to cure P-NETs. Even if radical resection is not suitable, palliative surgery may alleviate the patients, symptoms, and even prolong their survival time. According to the tumor location, size, quantity, degree of grading, local invasion and distant metastasis, different surgical procedures should be selected.