CAJ | 학술논문

目的探讨功能性胰岛细胞瘤术中B超引导下精准定位与切除的临床应用价值.方法回顾性分析2005年1月至2011年12月新疆医科大学第一附属医院收治的20例功能性胰岛细胞瘤患者的临床资料,总结其精确定位诊断方法、精准手术方式及预后情况.结果 21例患者术前行CT、MRI、腹部B超检查定位诊断阳性率分别为12/18、2/6、7/13,诊断的肿瘤直径分别为(1.7 ±0.8)cm、(1.3±0.2)cm、(1.9±0.9)cm；选择性动脉钙刺激静脉采血检查11例、胰腺灌注CT定位检查2例,定位诊断均为阳性,两种方法检测肿瘤直径分别为(0.7 ±0.3)cm和(0.9 ±0.4) cm.患者术中行B超检查阳性率为14/14,肿瘤直径为(1.5 ±0.6)cm.功能性胰岛细胞瘤采用常规手术6例,术后发生C级胰瘘2例、A级胰瘘1例；功能性胰岛细胞瘤采用精准切除术14例,术后发生A级胰瘘4例.20例患者均获得随访,截至2012年4月,患者一般情况良好,无死亡、恶变、转移或复发等情况发生.结论术前和术中多种定位方法结合能对功能性胰岛细胞瘤精确定位,对于病灶距离主胰管＞3 mm的患者建议采用胰岛细胞瘤的精准切除术.
목적 탐토공능성이도세포류술중B초인도하정준정위여절제적림상응용개치.방법 회고성분석2005년1월지2011년12월신강의과대학제일부속의원수치적20례공능성이도세포류환자적림상자료,총결기정학정위진단방법、정준수술방식급예후정황.결과 21례환자술전행CT、MRI、복부B초검사정위진단양성솔분별위12/18、2/6、7/13,진단적종류직경분별위(1.7 ±0.8)cm、(1.3±0.2)cm、(1.9±0.9)cm；선택성동맥개자격정맥채혈검사11례、이선관주CT정위검사2례,정위진단균위양성,량충방법검측종류직경분별위(0.7 ±0.3)cm화(0.9 ±0.4) cm.환자술중행B초검사양성솔위14/14,종류직경위(1.5 ±0.6)cm.공능성이도세포류채용상규수술6례,술후발생C급이루2례、A급이루1례；공능성이도세포류채용정준절제술14례,술후발생A급이루4례.20례환자균획득수방,절지2012년4월,환자일반정황량호,무사망、악변、전이혹복발등정황발생.결론 술전화술중다충정위방법결합능대공능성이도세포류정학정위,대우병조거리주이관＞3 mm적환자건의채용이도세포류적정준절제술.
Objective To investigate the clinical value of intraoperative ultrasound guided precise positioning and enucleation of the functional islet cell tumor.Methods The clinical data of 20 patients with functional islet cell tumor who were admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2005 to December 2011 were retrospectively analyzed.The method of precise positioning,surgical approach and prognosis of the patients were reviewed.Results The accurate rates of computed tomography (CT),magnetic resonance imaging (MRI) and transabdominal B ultrasound in detecting the position of the functional islet cell tumors were 12/18,2/6 and 7/13,respectively,and the diameters of the tumors were (1.7 ±0.8)cm,(1.3 ±0.2)cm and (1.9 ±0.9)cm,respectively.The accurate rates of arterial stimulation venous sampling and pancreatic perfusion CT imaging were 100％,and the diameters of the tumor detected were (0.7 ± 0.3) cm and (0.9 ± 0.4) cm.The accurate rate of intraoperative B ultrasound examination was 14/14,and the diameter of the tumor was (1.5 ± 0.6)cm.Routine surgery was carried out on 6 patients,and 2 patients were complicated with grade C pancreatic fistula,and 1 was complicated with grade A pancreatic fistula.Fourteen patients received precise enucleation of islet cell tumor,and 4 patients were complicated with grade A pancreatic fistula.Twenty patients were followed up.The general condition of the patients was good till April 2012,and no death,tumor recurrence and metastasis were detected.Conclusions Combination of pre-and intraoperative imaging positioning could precisely locate functional islet cell tumor.If the distance between the tumor and main pancreatic duct is above 3 mm,precise enucleation of the islet cell tumor should be considered.