非功能性胰岛细胞瘤41例的外科治疗

Operative management of nonfunctioning islet cell tumor

目的探讨巨大非功能胰岛细胞瘤 (NIT)的术式选择。方法 1978～ 2 0 0 2年收治NIT 4 1例 ,其中胰头体部肿瘤 2 8例 ,胰体尾部肿瘤 13例 ,瘤体长径平均为 10 7cm。行肿瘤摘除术15例 (胰头部 13例 ,胰体尾部 2例 ) ,胰腺切除术 2 1例 (胰十二指肠切除术 10例 ,胰体尾切除术11例 ) ,因肿瘤广泛浸润未能切除 5例。行肿瘤摘除术者瘤体长径平均为 9 6cm ,胰十二指肠切除术者为 13 1cm ,胰体尾切除术者为 9 9cm ,未能切除者为 11 6cm。结果治愈性切除率为 88%。肿瘤摘除术后并发症发生率为 33% ,主要为胰瘘 ;胰腺切除术后并发症发生率为 14 %。两种术式术后均无局部复发。摘除术 15例中有 3例在术后出现肝转移。结论对NIT可依据探查所见酌情选用肿瘤摘除术或胰腺切除术。两种术式术后均无局部复发 ,并发症发生率大致相等。

ObjectiveTo evaluate the surgical modality for the treatment of huge nonfunctioning islet cell tumor (NIT).MethodsFrom 1978 to 2002, 41 patients with NIT were treated in our hospital. Tumor located in the head of the pancreas in 28 patients, in the body or tail in 13 patients. The average diameter of the tumor was 10 7 cm. Fifteen patients underwent tumor enucleation, 21 did pancreatectomy. Tumors were unresectable in 5 because of wide infiltration. The mean diameter of tumor was 9 6 cm in patients treated by enucleation, 13 1 cm in those treated by pancreaticoduodenectomy, 9 9 cm in those by distal pancreatectomy and 11 6 cm in unresectable patients.ResultsThe curative resection rate was 88%. The complication rate after enucleation was 33%, and 14% after pancreatectomy. There was no local recurrence after both pancreatectomy and enucleation. Liver metastasis developed in 3 patients after tumor enucleation.ConclusionBoth enucleation and pancreatectomy are effective therapy for NIT with no postoperative local recurrence and comparable postoperative complication rates.