上海医药
上海醫藥
상해의약
SHANGHAI MEDICAL & PHARMACEUTICAL JOURNAL
2014年
4期
3-7
,共5页
胰腺内分泌肿瘤%诊断%外科治疗%预后
胰腺內分泌腫瘤%診斷%外科治療%預後
이선내분비종류%진단%외과치료%예후
pancreatic endocrine tumor%diagnosis%surgical treatment%prognosis
目的：探讨胰腺内分泌肿瘤(pancreatic endocrine tumours, PET)的临床特点，藉以提高临床诊治水平。方法：对我院1973年1月至2006年12月收治的77例PET患者的临床、病理资料进行回顾性分析。结果：本组女性46例（59.7%）；功能性PET占72.7%；良性为81.8%。术前B超和CT检查发现65例（84.4%）有胰腺占位病变；单发肿瘤位于胰头、体、尾部，分别为18.2%、28.6%和45.5%；多发肿瘤6例。肿瘤最大径8 cm。所有病例均得到病理检查，显示胰岛素瘤43例（55.8%），胃泌素瘤7例，胰高血糖素瘤5例，血管活性肠肽瘤1例，余21例为无功能PET。2例胃泌素瘤合并甲状旁腺瘤，为Ⅰ型多发性內分泌瘤。胰高血糖素瘤表现为游走性坏死性红斑、大泡性皮损和糖尿病。血管活性肠肽瘤表现为腹泻和低钾血症；无功能PET主要症状为反复中上腹隐痛。手术治疗PET的主要术式为肿瘤局部切除术（53例，68.8%）。手术后43例胰岛素瘤患者中，39例血糖恢复正常；胃泌素瘤、胰高血糖素瘤和血管活性肠肽瘤患者的术后症状均有缓解或完全消失。胰漏是主要的术后并发症。结论：PET发病隐匿,根据B超和CT检查可明确肿瘤的位置。最终诊断根据病理检查。本病预后明显好于胰腺癌，因此一旦明确诊断，应争取彻底切除肿瘤。恶性PET伴转移者的术后病死率较高。
目的：探討胰腺內分泌腫瘤(pancreatic endocrine tumours, PET)的臨床特點，藉以提高臨床診治水平。方法：對我院1973年1月至2006年12月收治的77例PET患者的臨床、病理資料進行迴顧性分析。結果：本組女性46例（59.7%）；功能性PET佔72.7%；良性為81.8%。術前B超和CT檢查髮現65例（84.4%）有胰腺佔位病變；單髮腫瘤位于胰頭、體、尾部，分彆為18.2%、28.6%和45.5%；多髮腫瘤6例。腫瘤最大徑8 cm。所有病例均得到病理檢查，顯示胰島素瘤43例（55.8%），胃泌素瘤7例，胰高血糖素瘤5例，血管活性腸肽瘤1例，餘21例為無功能PET。2例胃泌素瘤閤併甲狀徬腺瘤，為Ⅰ型多髮性內分泌瘤。胰高血糖素瘤錶現為遊走性壞死性紅斑、大泡性皮損和糖尿病。血管活性腸肽瘤錶現為腹瀉和低鉀血癥；無功能PET主要癥狀為反複中上腹隱痛。手術治療PET的主要術式為腫瘤跼部切除術（53例，68.8%）。手術後43例胰島素瘤患者中，39例血糖恢複正常；胃泌素瘤、胰高血糖素瘤和血管活性腸肽瘤患者的術後癥狀均有緩解或完全消失。胰漏是主要的術後併髮癥。結論：PET髮病隱匿,根據B超和CT檢查可明確腫瘤的位置。最終診斷根據病理檢查。本病預後明顯好于胰腺癌，因此一旦明確診斷，應爭取徹底切除腫瘤。噁性PET伴轉移者的術後病死率較高。
목적：탐토이선내분비종류(pancreatic endocrine tumours, PET)적림상특점，자이제고림상진치수평。방법：대아원1973년1월지2006년12월수치적77례PET환자적림상、병리자료진행회고성분석。결과：본조녀성46례（59.7%）；공능성PET점72.7%；량성위81.8%。술전B초화CT검사발현65례（84.4%）유이선점위병변；단발종류위우이두、체、미부，분별위18.2%、28.6%화45.5%；다발종류6례。종류최대경8 cm。소유병례균득도병리검사，현시이도소류43례（55.8%），위비소류7례，이고혈당소류5례，혈관활성장태류1례，여21례위무공능PET。2례위비소류합병갑상방선류，위Ⅰ형다발성내분비류。이고혈당소류표현위유주성배사성홍반、대포성피손화당뇨병。혈관활성장태류표현위복사화저갑혈증；무공능PET주요증상위반복중상복은통。수술치료PET적주요술식위종류국부절제술（53례，68.8%）。수술후43례이도소류환자중，39례혈당회복정상；위비소류、이고혈당소류화혈관활성장태류환자적술후증상균유완해혹완전소실。이루시주요적술후병발증。결론：PET발병은닉,근거B초화CT검사가명학종류적위치。최종진단근거병리검사。본병예후명현호우이선암，인차일단명학진단，응쟁취철저절제종류。악성PET반전이자적술후병사솔교고。
Objective: To investigate the diagnosis and surgical treatment of pancreatic endocrine tumours (PET). Methods:The clinical data of 77 cases with PET from 1973 to 2006 in our hospital were analyzed retrospectively. Results: Forty-six (59.7%) cases were female. The functional PET accounted for 72.7% and benign 81.8%. Sixty-five (84.4%) cases were diagnosed as pancreatic lesions by CT and ultrasonography preoperatively. The single lesion was located at head (18.2%), body (28.6%) and tail (45.5%) of pancreas and 6 cases had multiple PET. The diameter of the largest tumor was 8 cm. All of 77 cases were identified by pathological examination, of which 43 (55.8%) cases were insulinoma, 7 cases gastrinoma, 5 cases glucagonoma, 1 case vipoma and 21 cases nonfunctional PET. Two cases with gastrinoma complicated parathyroidoma were diagnosed as multiple endocrine neoplasia type 1 (MEN1). The patients with glucagonoma experienced diabetes and skin damage. Vipoma patient had diarrhea and kaliopenia. Nonfunctioning PET cases showed upper abdominal pain. The mainway for the surgical treatment of PET was local tumor resection. Blood glucose was returned to normal postoperatively in 39 of 43 cases with insulinoma. The postoperative symptoms of the patients with gastrinoma, glucagonoma and vipoma disappeared or relieved at some extent. Pancreatic leakage was the main postoperative complication. Conclusions: The onset of PET conceals. The location of PET may be identiifed with ultrasonography and CT. The ifnal diagnosis depends on pathological examination. The prognosis of PET is better than that of pancreatic cancer obviously. Therefore the best selection to treat PET is to resect the lesion completely when the diagnosis is set up. However malignant PET with metastasis has higher postoperative mortality.
