无功能性胰岛细胞肿瘤16例诊疗分析

A Retrospective Study of Diagnosis and Treatment of 16 Cases of Nonfunctioning islet Cell Tumors

目的 :总结胰腺无功能性胰岛细胞肿瘤的诊治经验。方法 :回顾分析近 10年我院收治的 16例无功能性胰岛细胞肿瘤的临床资料。男性 5例 ,女性 11例。平均年龄 4 1.9岁。肿瘤位于胰头 7例 (44 % )、胰颈部 1例 (6 % )、胰体尾 8例 (5 0 % )。良性 5例 (31.3% ) ,低度恶性 6例 (37.5 % ) ,恶性 5例 (31.3% )。术前得到影像学定性诊断者 7例 (43.8% ) ,得到定位诊断 13例 (81.3) %。结果 :14例接受了手术治疗。手术方式分别有肿瘤切除术、胰体尾切除术及肿瘤 +部分胰腺切除术。主要并发症为胰瘘 5例 (35 .7% )、腹腔脓肿 2例 (14 .3% )、假性囊肿形成 1例 (7.1% ) ,无手术死亡 ,均获痊愈。结论 :胰岛细胞肿瘤临床少见 ,易误诊和误治。CT和B超对定性和定位诊断准确率不高。加强对本病的认识并不断积累经验是诊断的关键。

Objective: To sum up the experience of diagnosis and treatment of nonfunctioning islet cell tumor in pancreas. Methods: We studied retrospectively the clinical aspects of 16 cases of nonfunctioning islet cell tumors in Zhongshan Hosital,Fudan University, in last 10 years. There are 5 male and 11 female patients. The localization of the tumors was as follows: 7 in pancreatic head, 1 in neck and 8 in body and tail. 5 tumors are benign, 6 low grade malignant and 5 malignant. The preoperative qualitative diagnosis of the tumors was accurate in 43.8%, and the localization of the tumors was accurately determined in 81.3% by B ultrasound and CT scan. Results: Local tumor enucleation, extensive local resections and resection of the body and tail of pancreas were performed in 14 cases respectively. Hospital morbidity included five self-limited pancreatic fistulas, two local abscesses and one pseudocyst formation. All were cured and there were no postoperative deaths. Conclusion: Nonfunctioning islet cell tumor in pancreas is rare clinically. It is often misdiagnosed and mistreated as other diseases. The diagnosis in quality and location of the tumor by B ultrasound and CT scan are not enough accurate. The key to the diagnosis lies in keeping aware of and accumulating the experience of it. Reasonable selection of surgery and well-done postoperative therapy are important for the prevention of complications.