胰腺神经内分泌肿瘤的腹腔镜治疗分析

Clinical analysis of totally laparoscopic surgery for pancreatic neuroendocrine neoplasms

目的:探讨胰腺神经内分泌肿瘤的腹腔镜治疗方法及效果。方法:2014年6月至2017年6月采用完全腹腔镜手术治疗胰腺神经内分泌肿瘤5例,其中男3例,女2例,患者32~62岁。无功能胰腺神经内分泌肿瘤3例,2例表现为腹部不适,1例无症状;功能性胰腺神经内分泌肿瘤2例,均为胰岛素瘤,表现为反复发作的低血糖症状。病程1周~5年。结果:5例均成功施行完全腹腔镜胰腺神经内分泌肿瘤切除术,术后经病理证实符合胰腺神经内分泌肿瘤。手术时间65~420 min,出血量50(20,700)ml,输血1例。术后平均住院(6.4±2.3)d。术后胰腺生化瘘2例,经保守治疗后痊愈。无术后出血、腹腔感染等严重并发症发生。结论:腹腔镜手术治疗无功能性胰腺神经内分泌肿瘤具有创伤小、康复快的优点,是安全、有效的治疗方法。对于功能性胰腺神经内分泌肿瘤,在术前、术中精准定位的基础上,也可选择腹腔镜手术治疗。

Objective： To discuss the clinical efficacy of totally laparoscopic surgery for pancreatic neuroendocrine neoplasms（ pNENs）. Methods： The clinical data of 5 patients who were scheduled for laparoscopic surgery of pNENs from Jun. 2014 to Jun. 2017 were retrospectively analyzed. 3 males and 2 females were enrolled in this study,with a median age of 53 years（ range 32 to 62 years）.3 cases got nonfunctional pNENs,in which two cases got clinical symptom of abdominal distension and one had no symptom; 2 cases got functional pNENs（ insulinoma） with symptom of recurrent attacks of hypoglycemia. The course of disease ranged from one week to 5 years. Results： Laparoscopic treatment of pNENs was successfully performed in 5 patients. The diagnosis of pNENs was confirmed by pathology for all the cases. The operative time was 65-420 min. The intraoperative blood loss was 50（ 20,700） ml,only one case accepted blood transfusion. The postoperative hospital stay was（ 6. 4 ± 2. 3） d. Two patients got postoperative pancreatic biochemical fistula and were cured by conservative treatment. Postoperative hemorrhage or abdominal infection was not found in any cases. Conclusions： Totally laparoscopic surgery is a safe,efficient and minimally invasive procedure for nonfunctional pNENs with quick recovery.And with accurate localization before and during operation,it is also a suitable method for functional pNENs.