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。     

胰岛细胞瘤的外科诊治经验——附19例报告

目的：探讨胰岛细胞瘤的外科诊断与治疗。方法：回顾分析近5年我院手术的治疗胰岛细胞瘤的经验，总结胰岛细胞瘤临床特征，诊治方法及其效果。结果：本组19例病例中，无功能性胰岛细胞瘤8例，胰岛素瘤11例，其中2例为多发性内分泌瘤瘤，前恶变率62．5％（5／8），平均年龄40岁，后恶变率9．8％（1／11），平均年龄39岁，肿瘤位于胰头8例，胰体6例，胰尾5例，术前影像诊断明确肿瘤定位15例（78．9％），其余4例定位可疑或不能定位经术中超声和触摸探查到定位，对肿瘤行局部切除术11例，胰体尾切除＋胰空肠吻合术5例，肿瘤＋脾脏切除术2例，Whipple手术1例，术后胰瘘发生率为31．6％（6／19），是最常见的并发症，无手术死亡病例。结论：无功能性胰岛细胞瘤恶变率显高于胰岛素瘤（P＜0．01）。术前不能确定肿瘤位置的，应联合应用于中超声和术触摸以探查肿瘤部位。胰岛素瘤手术方式多为单纯肿瘤切除，无功能性胰岛细胞瘤，术中常规冰冻切片检查，对可疑恶性应尽量采取根治性手术。     

胰岛细胞瘤的外科诊治经验--附19例报告

目的探讨胰岛细胞瘤的外科诊断与治疗.方法回顾分析近5年我院手术治疗胰岛细胞瘤的经验,总结胰岛细胞瘤临床特征、诊治方法及其效果.结果本组19例病例中,无功能性胰岛细胞瘤8例,胰岛素瘤11例,其中2例为多发性内分泌腺瘤.前者恶变率62.5%(5/8),平均年龄40岁;后者恶变率9.8%(1/11),平均年龄39岁.肿瘤位于胰头8例,胰体6例,胰尾5例.术前影像诊断明确肿瘤定位15例(78.9%),其余4例定位可疑或不能定位者经术中超声和触摸探查得到定位.对肿瘤行局部切除术11例,胰体尾切除+胰空肠吻合术5例,肿瘤+脾脏切除术2例,Whipple手术1例.术后胰瘘发生率为31.6%(6/19),是最常见的并发症,无手术死亡病例.结论无功能性胰岛细胞瘤恶变率显著高于胰岛素瘤(P<0.01).术前不能确定肿瘤位置的,应联合应用术中超声和术者触摸以探查肿瘤部位.胰岛素瘤手术方式多为单纯肿瘤切除;无功能性胰岛细胞瘤,术中常规冰冻切片检查,对可疑恶性者应尽量采取根治性手术.     

胰岛细胞瘤64例诊治分析

回顾性分析64例经手术治疗及病理证实的胰岛细胞瘤患者的临床资料,发现患者均具有典型的Whipple三联征,61例（95．3％）术前明确定位诊断。术中见肿瘤位于胰头16例、胰体27例、胰尾21例;53例行肿瘤切除术,10例行胰体尾切除术,5例联合脾切除术、1例行胰十二指肠切除术。术后病理证实为良性60例、恶性4例。术后血糖检测逐渐恢复正常,18例出现不同程度胰瘘。47例随访3个月～3a,2例复发,再次手术后痊愈;2例恶性者分别于术后6、13个月出现肝转移及腹腔转移。认为术前准确定位诊断,术中完整、彻底切除肿瘤是治疗胰岛细胞瘤的关键。     

非功能性胰岛细胞瘤11例报告

非功能性胰岛细胞瘤１１例报告孙重波，孙涛，王殿昌胰岛细胞瘤为起源于胰岛细胞的内分泌肿瘤，非功能性胰岛细胞瘤为一组临床上无特异的内分泌表现的胰岛肿瘤。我院自１９５６年至１９９１年共收治胰腺肿瘤５３８例，其中非功能性胰岛细胞瘤１１例，均经病理证实。本文主...     

胰岛β细胞瘤5例误诊原因分析

胰岛 β细胞瘤 (又称胰岛素瘤 )的临床特征为反复发作空腹低血糖 ,进食或注射葡萄糖后迅速恢复 ,由偶发至频发 ,症状渐渐加重。近 2 0年来 ,我们共收治 16例胰岛β细胞瘤患者 ,其中 5例在病理证实前分别误诊为癫痫、癔病、一过性脑血管痉挛 ( TIA)、精神分裂症、动脉硬化性脑病等。现分析如下。临床资料 :本组男 2例 ,女 3例 ;年龄 2 4～ 51岁 ,首次发病至确诊时间为 0 .5～ 8年。主要表现为饥饿、劳累或精神刺激时头晕、心慌、四肢无力、出冷汗 ;其中1例发病时双目上翻、牙关紧闭、四肢抽搐、口吐白沫 ,继而昏迷 ,误诊为癫痫 ;另 1例反复…     

非功能胰岛细胞瘤23例临床分析

非功能胰岛细胞瘤临床少见 ,占胰岛细胞瘤的 1 5 %～ 41 % 〔1〕。 1 980～ 1 999年 ,我们收治该病患者 2 3例 ,占同期胰岛细胞瘤患者的2 7%。现分析报告如下。1　临床资料本组 2 3例 ,男性 7例 ,女性 1 6例 ;年龄 8～ 6 0岁 ,平均 2 9.5岁。就诊原因为上腹包块1 4例 ,上腹包块伴腹胀、纳差 7例 ,左上腹疼痛向背部放射 2例。肿块直径 2 .5～ 2 5 cm。3例伴有轻度贫血 ,Hb分别为 93g/L、96 g/L、1 0 0 g/L。 8例查 AFP及 CEA均阴性。全部病例血糖检查均正常。 2 0例行 B超检查 ,其中 8例显示胰腺部位实质性低回声团块 ;1 2例显示肿块内…     

无功能胰岛细胞瘤的诊断和治疗：附9例报告

无功能胰岛细胞瘤较功能性胰岛细胞瘤更少见,国内朱预报告过8例。1970～1987年间我们收治9例,现报告如下。     

hTERT、Sp1、c-myc在良恶性胰岛β细胞瘤中的表达差异

目的检测人端粒酶逆转录酶(hTERT)、刺激蛋白1(Sp1)和原癌基因转录因子(c-myc)在良、恶性胰岛β细胞瘤和正常胰岛β细胞组织中的表达,探讨三者与胰岛β细胞瘤的关系,为临床鉴别良、恶性胰岛β细胞瘤和判断预后提供理论依据。方法用免疫组化方法检测hTERT、Sp1、c-myc在27例良性、16例恶性胰岛β细胞瘤和20例正常胰岛β细胞组织中的表达,并行相关性分析。结果 hTERT、Sp1、c-myc在恶性胰岛β细胞瘤中的阳性表达率分别为81.2%、75.0%、87.5%,在良性胰岛β细胞瘤中的阳性表达率分别为25.9%、29.6%、14.8%,在正常胰岛β细胞组织中没有表达。hTERT、Sp1和c-myc在良、恶性胰岛β细胞瘤的表达差异均有统计学意义(P均<0.05),且在恶性胰岛β细胞瘤的表达明显高于良性胰岛β细胞瘤和正常胰岛β细胞组织;hTERT与Sp1、c-myc的表达呈明显正相关(r分别为0.992、0.893,P均<0.01)。结论端粒酶的激活在良、恶性胰岛β细胞瘤的发生发展中起重要作用。联合检测hTERT、Sp1和c-myc的表达可作为鉴别良、恶性胰岛β细胞瘤的手段。     

胰腺巨大胰岛细胞瘤一例

患者男性，15岁。左上腹被踢伤后腹痛5h，于2003年4月28日以“腹部闭合性损伤，失血性休克，腹膜炎，腹腔占位性病变”收住院。伤后出现恶心、乏力及口渴感，无明显心悸、头晕症状。查体：神志清，四肢湿冷，面色苍白。血压12／6．5kpa(90／50mmHg)，脉搏104次／min。口唇微绀。全腹压痛，尤以左上腹为重，伴轻微反跳痛及腹肌紧张，左上腹触诊饱     

Malignant nonfunctioning islet cell tumor of the pancreas with intrasplenic growth: a case report

BACKGROUND: We reported a case of malignant nonfunction islet cell tumor (10.0 cm in diameter) of the pancreas, with malignant histological features and splenic infiltration. The case is rare, and few reports have been published. METHODS: A 46-year-old woman with a vague pain in the left upper quadrant for 3 months was found to have a tumor in the spleen. Ultrasonography and computed tomography demonstrated a well-defined pancreatic tumor of 8.2×10.0 cm in size, her serum levels of pancreatic hormones were within normal limits. RESULTS: Splenectomy combined with pancreatectomy was performed for the tail of the pancreas. Resected specimens showed a malignant nonfunctioning islet cell tumor invading the spleen. CONCLUSIONS: The growth pattern of the tumor causes malignant features. Resection of the tumor should be performed by enucleation, pancreaticoduodenectomy or distal pancreatectomy.     

A minute nonfunctioning islet cell tumor demonstrating malignant features

We report a patient with a minute nonfunctioning islet cell tumor, 8 mm in diameter, which demonstrated malignant features by histology. The patient was a 43‐year‐old Japanese woman, who had an elevated carbohydrate antigen (CA) 19‐9 level, of 59 U/ml (normal range, <37 U/ml) identified on a health check to rule out malignancies. Ultrasonography and computed tomography demonstrated a well‐defined pancreatic tumor, 8 mm in diameter, in the body of the pancreas. Serum levels of pancreatic hormones were within normal limits, and thus a tentative diagnosis was nonfunctioning islet cell tumor. The size of the tumor remained unchanged for 1¹/₂ years, but, at this time, the serum level of CA19‐9 was elevated to 253 U/ml. Segmental pancreatectomy was performed because malignancy could not be ruled out. The resected specimen showed an endocrine tumor invading both the pancreatic parenchyma and the perineural spaces outside the tumor. In general, minute nonfunctioning islet cell tumors have been considered to be completely benign, but the present tumor showed clear malignant features. We might have to take surgical resection into consideration even if the size of such an endocrine tumor is minute.     

A case of nonfunctioning islet cell tumor with hyperammonemia and hyperamylasemia

A case of nonfunctioning islet cell tumor with hyperammonemia and hyperamylasemia is reported. A 67-year-old female was admitted in an unconsciousness state, with a large abdominal mass about 10×10 cm in size. Hyperammonemia and hyperamylasemia were evident. Blood sugar levels, electroencephalogram (EEG), and brain scan were normal. After admission, lactulose and gabexate mesilate were administered for the hyperammonemia and hyperamylasemia. Serum ammonia levels returned to the normal range within 2 weeks, but serum amylase levels failed to decrease. Results of the oral glucose tolerance test were normal. A contrast computed tomographic (CT) scan revealed a tumor with a homogeneous enhancement pattern. Angiography demonstrated a hypervascular pancreatic tumor. Distal pancreatectomy with splenectomy was performed on the basis of a preoperative diagnosis of pancreatic tumor with extrapancreatic growth. Histological examination showed nonfunctioning islet cell tumor, with evidence of vascular invasion of tumor cells. Production of pancreatic hormones was not noted. The patient promptly returned to normal consciousness, and no elevation of ammonia or amylase was observed other than an incidental elevation of the latter due to pseudocyst formation. The hyperamylasemia was obviously related to tumor growth, and the pancreatic tumor itself may have contributed to the hyperammonemia.     

Management of nonfunctioning islet cell tumors

AIM: To more clearly define the clinical and pathological characteristics and appropriate diagnosis and treatment of nonfunctioning (NFICTs) islet cell tumors, and to review our institutional experience over the last 30 years. METHODS: The records of 43 patients confirmed to have nonfunctioning islet cell tumors of pancreas were retrospectively reviewed. Survival was estimated by the Kaplan-Meier methods and potential risk factors for survival were compared with the log-rank tests. RESULTS: The mean age was 31.63 years (range, 8 to 67 years). There were 7 men and 36 women. Twenty-eight patients had a confirmed diagnosis of nonfunctioning islet cell carcinoma (NFICC) and benign islet cell tumors were found in 15 patients. The most common symptoms in patients with NFICTs were abdominal pain (55.8%), nausea and/or vomiting (32.6%), fatigue (25.6%) and abdominal mass (23.3%). Preoperative ultrasonic and computed tomography localized the tumors in all patients. Forty-three NFICTs were distributed throughout the pancreas, with 21 located to the right of the superior mesenteric vessels, 10 in the body of the pancreas, 6 in the tail of the pancreas, and multiple tumors were found in one patient. Thirty-nine of 43 patients (91%) underwent surgical resection. Surgical treatment was curative in 30 patients (70%) and palliative in 9(21%). The resectability and curative resection rate in patients with NFICC of pancreas were 89% and 61%, respectively. The overall cumulative 5- and 10-year survival rates for patients with NFICC were 58.05% and 29.03%, respectively. Radical operation and diameter of cancer small than 10 cm were positive prognostic factors in females younger than 30 years old. Multivariate Cox regression analysis indicated that radical operation was the only independent prognostic factor, P=0.007. CONCLUSION: Nonfunctioning islet cell tumors of pancreas are found mainly in young women. The long-term results for patients undergone surgery, especially curative resection are good.     

胰腺囊性肿瘤的诊断与治疗——附41例报告

目的探讨胰腺囊性肿瘤的诊断和治疗。方法对本院1990年6月至2004年6月收治的41例胰腺囊性肿瘤患者的临床特点进行回顾性分析。结果胰腺囊性肿瘤好发于中青年女性，无急性胰腺炎，无上腹部手术及外伤史。临床表现以上腹部肿块和疼痛不适较为多见。影像学检查胰腺肿块为囊性，囊实性或不规则分叶状。肿瘤位于胰头部14例，胰体尾部27例。行不同术式的肿瘤切除35例，内引流3例，剖腹探查、肿瘤活检2例，1例拒绝于术治疗。有效随访34例，随访12个月～13年，22例囊腺瘤，17例仍生存；12例囊腺癌，生存时间〈12个月2例，12个月至2年4例，6例健在，其中5年以上3例，最长1例已生存7年。结论提高对胰腺囊性肿瘤的认识，减少误诊和积极的手术切除是改善其预后的主要措施。     

胰腺囊性肿瘤的诊断与治疗--附41例报告

目的探讨胰腺囊性肿瘤的诊断和治疗.方法对本院1990年6月至2004年6月收治的41例胰腺囊性肿瘤患者的临床特点进行回顾性分析.结果胰腺囊性肿瘤好发于中青年女性,无急性胰腺炎,无上腹部手术及外伤史.临床表现以上腹部肿块和疼痛不适较为多见.影像学检查胰腺肿块为囊性,囊实性或不规则分叶状.肿瘤位于胰头部14例,胰体尾部27例.行不同术式的肿瘤切除35例,内引流3例,剖腹探查、肿瘤活检2例,1例拒绝手术治疗.有效随访34例,随访12个月～ 13年,22例囊腺瘤,17例仍生存;12例囊腺癌,生存时间 < 12个月2例,12个月至2年4例,6例健在,其中5年以上3例,最长1例已生存7年.结论提高对胰腺囊性肿瘤的认识,减少误诊和积极的手术切除是改善其预后的主要措施.