CAJ | 학술논문

目的探讨腹腔镜手术治疗胰腺神经内分泌肿瘤(pNENs)的临床疗效.方法回顾性分析2005年3月至2014年6月浙江大学医学院附属邵逸夫医院收治的31例行腹腔镜手术治疗pNENs患者的临床资料.根据肿瘤位置及大小选择具体术式.采用电话和门诊方式进行随访,随访时间截至2014年8月.结果 31例患者成功完成腹腔镜手术,其中腹腔镜胰腺肿瘤剜除术4例,腹腔镜胰十二指肠切除术2例,腹腔镜中段胰腺切除术2例,腹腔镜保留脾脏胰体尾切除术6例,腹腔镜胰体尾联合脾脏切除术17例.手术时间为(205±74) min,术中平均出血量为125 mL(10～1 000 mL),术中输血率为9.7％ (3/31).术后平均下床活动时间为2d(1 ～3d),术后肛门平均排气时问为3 d(1～4d),术后平均进食流质饮食时间为3d(1 ～7 d),术后平均住院时间为10 d(5 ～63 d).术后并发症发生率为35.5％(11/31),均经对症处理后痊愈.无围手术期死亡患者.31例患者获得术后随访.中位随访时间为21个月(5～111个月).1例患者术后即出现胰腺外分泌功能不足表现;3例患者术后1个月出现糖尿病;1例患者术后1年因肿瘤广泛转移死亡;1例患者术后3年再次出现Whipple三联征,经MRI检查及术中超声证实胰头、胰尾部多发肿瘤.其余患者未出现肿瘤复发或转移.结论腹腔镜手术治疗pNENs创伤小、恢复快,近、远期疗效好,安全可行.其具体术式选择主要取决于肿瘤的位置和大小.
목적 탐토복강경수술치료이선신경내분비종류(pNENs)적림상료효.방법 회고성분석2005년3월지2014년6월절강대학의학원부속소일부의원수치적31례행복강경수술치료pNENs환자적림상자료.근거종류위치급대소선택구체술식.채용전화화문진방식진행수방,수방시간절지2014년8월.결과 31례환자성공완성복강경수술,기중복강경이선종류완제술4례,복강경이십이지장절제술2례,복강경중단이선절제술2례,복강경보류비장이체미절제술6례,복강경이체미연합비장절제술17례.수술시간위(205±74) min,술중평균출혈량위125 mL(10～1 000 mL),술중수혈솔위9.7％ (3/31).술후평균하상활동시간위2d(1 ～3d),술후항문평균배기시문위3 d(1～4d),술후평균진식류질음식시간위3d(1 ～7 d),술후평균주원시간위10 d(5 ～63 d).술후병발증발생솔위35.5％(11/31),균경대증처리후전유.무위수술기사망환자.31례환자획득술후수방.중위수방시간위21개월(5～111개월).1례환자술후즉출현이선외분비공능불족표현;3례환자술후1개월출현당뇨병;1례환자술후1년인종류엄범전이사망;1례환자술후3년재차출현Whipple삼련정,경MRI검사급술중초성증실이두、이미부다발종류.기여환자미출현종류복발혹전이.결론 복강경수술치료pNENs창상소、회복쾌,근、원기료효호,안전가행.기구체술식선택주요취결우종류적위치화대소.
Objective To investigate the clinical efficacy of laparoscopic resection for pancreatic neuroendocrine neoplasms (pNENs).Methods The clinical data of 31 patients who received laparoscopic resection for pNENs at the Sir Run Run Show Hospital of Zhejiang University from March 2005 to June 2014 were retrospectively analyzed.The surgical procedure was selected according to the location and size of the pNENs.Patients were followed up via phone call or out-patient examination till August 2014.Results Laparoscopic resection was successfully carried out on all the 31 patients,including laparoscopic enucleation in 4 patients,laparoscopic pancreatoduodenectomy in 2 patients,laparoscopic central pancreatectomy in 2 patients,laparoscopic spleenpreserving distal pancreatectomy in 6 patients and laparoscopic distal pancreatosplenectomy in 17 patients.The operation time,volume of intraoperative blood loss and blood transfusion rate were (205 ± 74)minutes,125 mL (10-1 000 mL) and 9.7％ (3/31),respectively.The time for out-off-bed activity,time to anal exsufflation,time for fluid diet intake and duration of postoperative hospital stay were 2 days (range,1-3 days),3 days (range,1-4 days),3 days (range,1-7 days) and 10 days (range,5-63 days).The incidence of postoperative complications was 35.5％ (11/31),and the complications were cured after symptomatic treatment.No patient died perioperatively.Thirty-one patients were followed up with the follow-up rate of 100.0％.The median time for followup was 21 months (range,5-111 months).One patient had symptom of pancreatic exocrine insufficiency after the operation; 3 patients had diabetes at postoperative month 1 ; 1 patient died of tumor metastases at postoperative year 1 ; 1 patient had Whipple's triad at postoperative year 3,and was confirmed with tumors in the head and tail of the pancreas by magnetic resonance imaging.No tumor recurrence or metastasis was detected in the other patients.Conclusions Laparoscopic resection is safe and feasible for the treatment of pNENs.The surgical procedure is selected based on the location and size of the pNENs.Laparoscopic resection of pNENs has the advantages of small trauma,quick recovery of the patients and favorable short-and long-term efficacy.