CAJ | 학술논문

目的总结胰腺神经内分泌肿瘤(pNENs)的诊断及治疗经验.方法回顾性分析安徽医科大学附属省立医院2002年1月至2013年12月收治的47例pNENs患者临床资料.采用电话和门诊复诊的方式进行随访,随访截止时间为2014年1月31日.采用Kaplan-Meier法对患者生存情况进行分析,并分析影响患者生存期的因素.结果 47例患者中男性13例,女性34例,年龄16～74岁,中位年龄45岁.无功能性pNENs 17例,功能性pNENs 30例.B超、CT、MRI检查的肿瘤检出率分别为71.8％ (28/39)、92.7％ (38/41)、75.0％ (6/8).46例行根治性手术,1例行姑息性手术.病理类型包括胰腺神经内分泌瘤41例,神经内分泌癌6例.肿瘤分级G1、G2、G3级分别为22、19、6例,TNM分期Ⅰ、Ⅱ、Ⅲ、Ⅳ期分别为32、11、4、0例.肿瘤侵犯血管15例,侵犯神经18例;检查淋巴结15例,其中转移性5例.术后出现胰瘘9例,腹腔积液4例,切口感染4例.随访2～144个月,患者1、3、5年的总体生存率分别为94.9％、88.4％、84.4％;G1、G2、G3级5年生存率分别为100％、73.3％、60.0％;TNM分期Ⅰ、Ⅱ、Ⅲ期5年生存率分别为100％、70.0％、33.3％.肿瘤分级、TNM分期、淋巴结转移、神经侵犯、血管侵犯等因素与pNENs患者预后相关.结论 CT是诊断pNENs首选的影像学检查方法,外科手术是首选的治疗手段.手术切除患者可获得长期生存,肿瘤分级及分期,淋巴结转移,血管、神经侵犯与pNENs患者预后密切相关.
목적 총결이선신경내분비종류(pNENs)적진단급치료경험.방법 회고성분석안휘의과대학부속성립의원2002년1월지2013년12월수치적47례pNENs환자림상자료.채용전화화문진복진적방식진행수방,수방절지시간위2014년1월31일.채용Kaplan-Meier법대환자생존정황진행분석,병분석영향환자생존기적인소.결과 47례환자중남성13례,녀성34례,년령16～74세,중위년령45세.무공능성pNENs 17례,공능성pNENs 30례.B초、CT、MRI검사적종류검출솔분별위71.8％ (28/39)、92.7％ (38/41)、75.0％ (6/8).46례행근치성수술,1례행고식성수술.병리류형포괄이선신경내분비류41례,신경내분비암6례.종류분급G1、G2、G3급분별위22、19、6례,TNM분기Ⅰ、Ⅱ、Ⅲ、Ⅳ기분별위32、11、4、0례.종류침범혈관15례,침범신경18례;검사림파결15례,기중전이성5례.술후출현이루9례,복강적액4례,절구감염4례.수방2～144개월,환자1、3、5년적총체생존솔분별위94.9％、88.4％、84.4％;G1、G2、G3급5년생존솔분별위100％、73.3％、60.0％;TNM분기Ⅰ、Ⅱ、Ⅲ기5년생존솔분별위100％、70.0％、33.3％.종류분급、TNM분기、림파결전이、신경침범、혈관침범등인소여pNENs환자예후상관.결론 CT시진단pNENs수선적영상학검사방법,외과수술시수선적치료수단.수술절제환자가획득장기생존,종류분급급분기,림파결전이,혈관、신경침범여pNENs환자예후밀절상관.
Objective To summarize the experience of diagnosis and treatment for pancreatic neuroendocrine neoplasms (pNENs).Methods Forty-seven patients with pNENs who were treated at Anhui Province Hospital during January 2002 to December 2013 were retrospectively analyzed.They were followed by telephone or clinic interview,and the deadline date was January 31st,2014.Survival was analyzed with the Kaplan-Meier method,and the prognostic factors for survival were identified.Results Among the47 patients,there were 13 males and 34 females,aged from 16 to 74 years old,with a median age of 45 years,There were 17 cases of non-functioning pNENs,30 cases of functioning pNENs.The detection rate of B ultrasound,CT,MRI was 71.8％ (28/39),92.7％ (38/41),75.6％ (6/8).Forty-six patients underwent radical surgery,and 1 patient underwent palliative surgery.The pathologic type included 41 cases of pancreatic neuroendocrine neoplasms,6 cases of neuroendocrine cancer.There were 22,19,6 cases of grade G1,G2,G3 lesions,respectively.There were 32,11,4 cases of TNM staging Ⅰ,Ⅱ,Ⅲ,respectively.Vascular structure was invaded in 15 cases,and nerve was invaded in 18 cases.Lymph node was examined in 15 cases,and 5 were found to have metastatic lesion.After surgery,pancreatic fistula occurred in 9 patients,ascites in 4 patients,wound infection in 4.The follow-up period ranged from 2 to 144 months.The overall 1,3,5-year survival rates were 94.9％,88.4％,and 84.4％.The 5-year survival rates of patients with grade G1,G2,G3 were 100％,73.3％,60％;and the 5-year survival rates of patients with TNM staging Ⅰ,Ⅱ,Ⅲ were 100％,70.0％,33.3％.It was showed that TNM staging system,WHO classification,lymph node metastasis,vascular and neural invasion were associated with the prognosis.Conclusions CT is the imaging test of choice for pNENs,while surgery is the first choice for treatment.Surgical resection of pNENs results in long-term survival.TNM staging,WHO classification,lymphatic metastasis,vascular and neural invasion are closely related to the prognosis of pNENs.