无功能性胰岛细胞瘤34例的诊治与预后分析

目的提高胰岛细胞瘤的诊断与治疗水平。方法对1986年1月～2001年10月间我院收治的34例无功能性胰岛细胞瘤病例进行回顾性分析。结果34例无功能性胰岛细胞瘤多以腹部包块和腹痛为首发症状。良性肿瘤28例，恶性6例。术前B超、CT及MRI检查可作肿瘤定位，其中30例肿瘤来源于胰腺。手术治疗33例，采用肿瘤切除术、远端胰腺切除加脾切除术、或Whipple手术，肿瘤恶性者术后辅以放、化疗。随访24例，其中良性18例，均存活；恶性6例中1例于术后6年死亡，5例存活，至目前已生存1年者2例，3年者2例，9年者1例。结论无功能性胰岛细胞瘤早期缺乏临床症状，不易发现。B超、CT及MRI是有效的影像学诊断方法。肿瘤对周围组织浸润和肿瘤转移是恶性胰岛细胞瘤最可靠的诊断标准。手术切除是无功能性胰岛细胞瘤的主要治疗方法，恶性者辅以放、化疗，预后一般较好。

Diagnosis and treatment of nonfunctioning islet cell tumor:report of 34 cases

Objective To improve diagnosis and treatment of nonfunctioning islet cell tumor (NIT).Methods 34 cases of NIT admitted between January 1986 to October 2001 were reviewed and analyzed retrospectively.Results The initial symptoms were abdominal masses and abdominal pain in all 34 cases of NIT,of which 28 cases were benign and the remaining 6 cases were malignant. All tumors were located by US,CT and MRI before operation. Of the 34 tumors,30 originated from the pancreas. 33 cases were managed surgically. The malignant tumors were treated by radiotherapy and chemotherapy after operation. 1 case with unresected tumor were treated by chemotherapy. Of the six patients with malignant tumors,one patient died in 6 years and the remaining five patients are still alive,of whom 2 patients have lived for 1 year,two patients for 3 years,and 1 patient for 9 years. Conclusions Early detection of nonfunctioning islet cell is usually difficult because of asymptomatic nature. US,CT and MRI are effective means of imaging diagnosis. Tumor infiltration to adjacent tissues and metastasis are credible evidence for the diagnosis of a malignant islet cell tumor. Surgical resection is the main treatment for NIT. Postoperative chemotherapy and radiotherapy are effective accessory treatment for malignant NIT,and the prognosis is usually good.