胰岛细胞瘤的外科诊治经验——附19例报告

Diagnosis and surgical treatment of islet cell adenomas:experience with 19 cases.

目的 探讨胰岛细胞瘤的外科诊断与治疗。方法 回顾分析近5年我院手术治疗胰岛细胞瘤的经验,总结胰岛细胞瘤临床特征、诊治方法及其效果。结果 本组19例病例中,无功能性胰岛细胞瘤8例,胰岛素瘤11例,其中2例为多发性内分泌腺瘤。前者恶变率62.5％(5/8),平均年龄40岁;后者恶变率9.8％(1/11),平均年龄39岁。肿瘤位于胰头8例,胰体6例,胰尾5例。术前影像诊断明确肿瘤定位15例(78.9％),其余4例定位可疑或不能定位者经术中超声和触摸探查得到定位。对肿瘤行局部切除术11例,胰体尾切除十胰空肠吻合术5例,肿瘤+脾脏切除术2例,Whipple手术1例。术后胰瘘发生率为31.6％(6/19),是最常见的并发症,无手术死亡病例。结论 无功能性胰岛细胞瘤恶变率显著高于胰岛素瘤(P<0.01)。术前不能确定肿瘤位置的,应联合应用术中超声和术者触摸以探查肿瘤部位。胰岛素瘤手术方式多为单纯肿瘤切除;无功能性胰岛细胞瘤,术中常规冰冻切片检查,对可疑恶性者应尽量采取根治性手术。

Objective To discuss the diagnosis and treatment of islet-cell adenoma. Methods 19 patients with islet-cell adenoma in recent 5 years were analyzed retrospectively. The clinical characteristics of islet cell adenoma and the therapeutic outcomes were summarized. Results Of the 19 patient investigated, 8 patients had dysfunctional Islet cell adenoma,and the remaining 11 patients had insulinomas (functional islet cell adenoma), of whom 2 had multiple endocrine tumor. The malignancy rate of the former group was 62. 5% (5/8)and that of the latter group was 9. 8% (1/11). The tumors were located in the pancreas head in 8 cases, in the pancreas body in 6 cases, and in the pancreas tail in 5 cases. The location of the tumors was confirmed preoperatively by imageology in 15 patients (78.9%), and that of the remaining tumors was detected by intraoperative ultrasonography and surgical exploration. Local excision was performed in 11 patients, distal pancreatectomy in 5 patients, pancreatectomy plus splenectomy in 2 patients, and Whipple operation in one patient. Pancreatic leakage was the most common complication (31. 6%). There was no postoperative mortality. Conclusions The malignancy rate of islet cell adenoma was significantly higher in the dysfunctional group than that in the functional group(P<0. 01). For those patients whose tumors were unable to be located before operation, combination of ultrasound and palpation was helpful. Local dissection may be enough for benign insulinomas. Radical operation should be considered for dysfunctional tumor or insulinoma which is suspected to be malignant on frozen section examination.