45例功能性胰腺内分泌肿瘤的诊断和治疗

目的 探讨功能性胰腺内分泌肿瘤(PETs)的诊断和治疗方法.方法 回顾性分析1998年1月至2008年12月第三军医大学西南医院收治的45例功能性PETs患者的临床资料.术前根据临床表现进行定性诊断,以腹部彩色多普勒超声、CT等检查进行定位诊断.实施胰体尾+脾切除术8例,肿瘤摘除术32例,胆胰结合部切除术1例,胰十二指肠切除术4例.术后给予相应化疗.结果 45例患者中,良性34例,恶性11例.肿瘤位于胰头8例,胰尾26例,胰体7例,胰腺内多发肿瘤4例;肿瘤直径为0.3～5.0 cm,其中>2.0 cm者19例.术后8例患者出现胰液漏,2例发生切口感染,1例发生腹腔感染.33例胰岛素瘤患者中,5例多发肿瘤患者术后血糖未恢复正常,其中3例再次行手术治疗,2例口服胰岛素分泌抑制剂治疗,血糖均控制在正常范围;7例胃泌素瘤患者术后腹泻等临床症状消失,服用质子泵抑制剂治疗,半年后行电子胃镜检查示溃疡愈合,基础胃酸分泌及12 h胃液量均在正常范围;4例胰高血糖素瘤患者术后3周内坏死性游走性皮疹明显消失或明显减退,血氨基酸水平升高,糖尿病得以痊愈;1例恶性血管活性肠肽瘤患者术后腹泻、电解质紊乱得以纠正.45例患者中39例随访20～120个月,32例良性患者中2例复发,3例因其他疾病死亡;7例恶性患者中2例生存,3例因肝转移或肿瘤复发死亡,2例因其他疾病死亡.结论 外科治疗是功能性PETs有效的治疗方法.姑息性肿瘤切除术亦可明显改善患者的生命质量.     

13例胰腺胃泌素瘤的诊断和外科治疗

目的 探讨胰腺胃泌素瘤的诊断和治疗方法.方法 回顾性分析1990年1月至2011年12月期间海南省人民医院收治的13例胰腺胃泌素瘤患者的临床资料.术前根据临床表现及实验室检查结果进行定性诊断,以腹部彩色多普勒超声、CT等检查进行定位诊断.术后根据病理学结果给予相应的放化疗.结果 13例患者均行手术治疗.术中发现肿瘤位于胰头者9例,胰尾者1例,胰体者2例以及胰腺内多发肿瘤者1例;肿瘤直径为0.2～4.0cm,其中＞2.0 cm者11例.行胰体尾+脾切除术1例,行瘤摘除术7例,行胆胰结合部切除术2例,行胰十二指肠切除术3例.术后出现胰液漏1例,切口感染2例.13例中有12例获得随访,随访时间16～120个月,平均随访时间为78个月.12例胰腺胃泌素瘤患者术后腹泻等临床症状消失;服用质子泵抑制剂治疗,半年后行电子胃镜检查,显示溃疡均愈合,基础胃酸分泌及12 h胃液量均在正常范围内.1例因其他疾病于术后1年死亡;1例因肿瘤复发于1.5年后死亡,另1例因肝转移行再次手术治疗4年后死亡;其余10例痊愈.结论 外科治疗是胰腺胃泌素瘤有效的治疗方法.     

胰腺实性假乳头状瘤临床治疗体会

目的 分析6例胰腺实性假乳头状瘤病例,探讨其诊断、治疗方法.方法 对我院2005年1月至2008年6月期间收治的6例胰腺实性假乳头状瘤病例的临床资料进行回顾性分析.结果 6例患者年龄15～42岁,平均26.7岁;其中男1例,女5例.肿瘤位于胰头2例,胰体尾部4例.无特异性临床表现.血清肿瘤标志物均为阴性.2 例行胰十二指肠切除术,4例行胰体尾及脾切除术.6例患者均获随访,随访时间6～48个月,平均24个月,均未发现肿瘤复发、转移.结论 胰腺实性假乳头状瘤是一种罕见的低度恶性胰腺肿瘤,多发于青年女性;术前、术中明确诊断有助于术式的选择,提高患者的生存质量.     

胰腺实性假乳头状瘤43例诊疗及预后分析

目的探讨胰腺实性假乳头状瘤的诊断,治疗方法及预后。方法回顾分析2005年1月至2015年12月我院收治的43例胰腺实性假乳头状瘤行手术治疗病例的临床资料并随访其预后。结果男性5例,女性38例;年龄16～70岁,平均32. 4岁,多数患者因腹痛就诊。手术治疗包括胰十二指肠切除术6例,胰体尾加脾切除术15例,保脾胰体尾切除术6例,中段胰切除术5例,肿瘤局部剜除术11例。术后出现并发症13例(30. 2%),其中7例胰漏,2例切口液化,1例早期上消化道出血。32例获得随访,随访15～142个月,所有病人术后无复发、转移及死亡。结论胰腺实性假乳头状瘤好发于年轻女性,手术治疗效果较好。     

胰腺实性假乳头状瘤的诊断与治疗

目的 总结胰腺实性假乳头状瘤的诊断与治疗经验.方法 回顾性分析天津医科大学附属肿瘤医院2006年1月至2011年10月收治的24例胰腺实性假乳头状瘤患者的临床病理资料.结果 本组患者中男2例、女22例,中位年龄27.5岁(12～51岁).24例患者中11例肿瘤位于胰头,5例位于胰体,4例位于胰尾,3例位于胰体尾,1例位于胰颈体部.肿瘤直径平均为6.4cm(2.0～12.0 cm).该病无特异性临床表现,术前诊断主要依赖于彩超、CT、MR等影像学检查.所有患者均行手术切除治疗,经术后病理证实为胰腺实性假乳头状瘤.术后随访时间为2～55个月,中位随访时间27.2个月,23例患者无瘤生存,l例患者术后复发,带瘤生存. 结论 胰腺实性假乳头状瘤是一种少见的低度恶性胰腺肿瘤,多发于青年女性,完整手术切除可获得较好的预后.     

恶性无功能性胰腺神经内分泌肿瘤的外科治疗

目的 探讨恶性无功能性胰腺神经内分泌肿瘤的外科治疗方法及影响预后的因素.方法 回顾性分析33例术后病理检查证实为恶性无功能性胰腺神经内分泌肿瘤患者的临床资料.结果 12例行胰十二指肠切除术,8例行胰体尾切除术,5例行局部切除术,8例仅行活检.本组患者5年生存率为31%.25例肿瘤切除患者1、3、5年生存率分别为92%、76%、39%;8例肿瘤未切除患者1、3、5年生存率分别为81%、61%、0.肝转移和血管侵犯是影响预后的因素.结论 手术切除是恶性无功能性胰腺神经内分泌肿瘤的首选治疗方法;肝转移、血管侵犯是影响预后的独立危险因素.     

胰腺中段切除术在胰腺颈体部良性肿瘤的应用(附15例报告)

目的 探讨胰腺中段切除术在胰腺颈体部良性肿瘤中的临床实用价值.方法 对2005年11月至2009年6月期间收治的胰腺颈体部良性肿瘤并施行胰腺中段切除术的15例病例进行回顾性分析,男性3例,女性12例,年龄30～55岁,平均45岁.其中因上腹部胀痛不适入院4例,其余11例均为常规体检行腹部彩色超声检查发现.结果 本组患者无围手术期死亡.15例患者均行胰腺中段切除,其中14例行胰头断端闭锁、胰尾空肠吻术(单吻合术),1例行胰腺两断端空肠"Ω"吻合(双吻合术).术后病理检查结果显示,胰腺实性假乳头状瘤1例,无功能性胰岛细胞瘤3例,胰腺囊腺瘤11例.术后发生胰瘘3例,均在3个月内自行愈合.所有患者均获得随访,随访时间2～45个月,15例患者无死亡,无新发糖尿病,无肿瘤再发,无胰腺假性囊肿形成.结论 胰腺中段切除术治疗胰腺颈体部良性肿瘤临床效果确切,对患者内、外分泌功能影响小,胰瘘发生率高于胰头十二指肠切除术,只要通畅引流,多能自行愈合.     

胰腺实性假乳头状瘤的诊断和外科治疗

目的 探讨胰腺实性假乳头状瘤(SPT)的诊断和外科治疗方法.方法 回顾分析华中科技大学同济医学院附属协和医院胰腺外科中心自2003年至2007年收治的21例胰腺实性假乳头状瘤病人的临床、影像、手术以及随访资料.结果 21例确诊为胰腺实性假乳头状瘤的病人中,女18例,男3例,平均年龄33岁.病人的临床资料、影像学检查、术中探查对SPT的诊断及手术方式的选择具有较大的价值;其中行保留十二指肠的胰头切除术7例,3例行胰十二指肠切除术,其中2例因肿块侵犯血管行胰十二指肠切除联合血管切除及重建术,4例行胰腺节段切除术,5例行保留脾脏的胰体尾部分切除术,2例行胰尾切除联合脾脏切除,1例因肿瘤侵犯周围组织行胰体尾切除、脾脏切除术、左肾上腺部分切除术.术后病理学检查均证实为胰腺实性假乳头状瘤.随访结果显示所有病例均存活.结论 对SPT的诊断要充分重视病人的临床资料、影像学检查以及术中探查的结果,进而采用积极、恰当的手术切除治疗.     

胰腺实性假乳头状瘤45例手术治疗分析

目的总结胰腺实性假乳头状瘤的外科治疗体会。方法 45例胰腺实性假乳头状瘤患者,均行手术治疗,其中11例行胰腺局部切除术,20例行胰体尾切除术,5例行胰体尾联合脾脏切除术,9例行胰十二指肠切除术。结果 8例发生消化不良,2例患者术后发生胰瘘,胸腔积液2例,切口液化、感染2例,早期(术后24 h内)消化道出血1例。所有患者均保守治疗均痊愈出院。43例获得随访,随访时间6~160个月,平均(41.5±1.5)个月,术后均无转移、复发及死亡。结论腺假乳头状瘤为潜在低度恶性肿瘤,好发于年轻女性,手术是唯一根治的治疗方式,预后一般较好。     

胰岛细胞瘤32例诊治分析

目的:探讨胰腺内分泌肿瘤的诊断和外科治疗经验。方法:32例中行肿瘤摘除术18例,胰体尾联合脾切除术4例,胰十二指肠切除术4例,肿瘤切除并胃大部切除术2例,Whipple术3例,捆绑式胰体空肠吻合术1例。结果:B超、CT、MRI、DSA诊断胰岛细胞瘤的敏感性分别为62.5%、75%、80%、87.5%。术后并发症包括胰瘘、切口感染、腹腔内出血。结论:无功能胰岛细胞瘤恶性率显著高于功能性胰岛细胞瘤(P<0.01)。胰腺内分泌肿瘤的外科治疗方案主要取决于肿瘤的大小、定位和恶性度。对良性者宜行单纯肿瘤切除或胰腺部分切除,对恶性肿瘤应以扩大范围的根治性肿瘤切除术为主的综合治疗。     

Secondary arterio-enteric fistulae: a surgical challenge

Ten cases of secondary arterio-enteric fistulae are described. There were nine graft enteric fistulae and one fistula involving the aortic suture line following elective resection of an infected graft. Only four of the patients initially received prophylactic antibiotics (single dose) at the original aortic reconstruction, and the vascular suture line had only been protected in two. Eight patients presented with bleeding and two with groin abscesses. One patient died before operation. Graft resection was undertaken in all patients and organisms were grown from six of eight grafts cultured. No patient died during operation but one died after 3 days. Axillofemoral bypass grafts were constructed in seven patients (four immediately after resection of prosthetic grafts and three within 4 days of operation). Only three of the eight patients who survived operation are still alive; two died of a ruptured aorta and one from a recurrent fistula. Two patients died of other causes. Four of five axillofemoral grafts in surviving patients subsequently occluded.     

Surgical treatment of high bleeding gastric ulcer

In the surgical treatment of 68 consecutive patients with benign, high, bleeding gastric ulcer between 1966 and 1981, the following operative procedures were used; high gastric resection in 31 (45.5%) cases, local ulcer excision with truncal vagotomy and pyloroplasty in 23 (33.8%), local ulcer excision with low gastric resection in 11 (16.2%) and a local procedure alone in three (4.5%) cases. Of these 68 operations, 40 (59%) were early elective operations and 28 (31%) acute or emergency operations. Altogether, six (8.9%) patients died postoperatively, all but one after acute or emergency operation. High gastric resection was the most risky operation and five of the six deaths were in this operative group. Nonfatal complications developed in 18 (26.4%) cases but without correlation to the timing or to the type of operation. Early rebleeding during the hospital stay necessitating reoperation occurred in three (4.4%) patients, two of these among the three cases operated on using a local procedure and without a definitive operation. During the follow-up five (7.3%) recurrent ulcers developed, four after local ulcer excision with truncal vagotomy and pyloroplasty and one after high gastric resection. It seems to us that in the treatment of patients with high gastric ulcer, local operation alone is never acceptable. High gastric resection is often technically hazardous with a high postoperative mortality rate. The best methods seemed to be local ulcer excision combinated with truncal vagotomy and pyloroplasty or, perhaps preferably, with low gastric resection.     

结直肠癌性梗阻的外科治疗: 附108例报告

目的　探讨结直肠癌性梗阻的治疗原则。方法　回顾性分析 10年间我院收治的 10 8例结肠梗阻患者的临床资料和治疗方法 :右半结肠癌 3 0例中 2 8例行一期切除吻合 ,1例行姑息性手术 ,1例未手术。左半结肠和直肠癌 78例中行一期切除 ( 5 6例 ) (Ⅰ期或Ⅱ期吻合分别 3 2 ,2 4例 )或二期切除11例 ,6例行姑息性手术 ,5例未手术。结果　伴结肠梗阻的结直肠癌多见于Duke′sC和D期 ( 5 9例 )的中、低分化腺癌 ( 65例 )。手术并发症发生率为 2 7.3 % ( 2 6例 46例次 ) ,以感染性并发症为主 ( 3 5 /46) ,吻合口漏 4例。围手术期死亡率为 7.8%。手术治疗患者的 5年生存率为 2 8.4% ,未手术者 5年生存率为 0 % (P <0 .0 1)。肿瘤I期 ,II期切除 5年生存率分别为 3 3 .3 % ,9.0 % (P <0 .0 5 )。肿瘤一期切除后行一期 ,二期吻合手术的 5年生存率无显著性差异 (P >0 .0 5 )。结论　对伴结肠梗阻的结直肠癌 ,手术应及时并遵循个体化原则 ,创造条件 ,要力争一期手术切除肿瘤 ,解除梗阻 ,但切除后行I期或II期吻合对预后无影响。     

胰腺素腺瘤和囊腺癌的诊治

目的 探讨胰腺囊性肿瘤的诊断和治疗。方法 对1978-1998年收治的均经手术和病理检查证实为胰腺囊性肿瘤的11例临床资料进行回顾性分析。结果 胰腺囊性肿瘤好发于中青年女性,临床表现为病程较长的上腹部肿物和胀痛。钡餐、B超、CT及ER-CP能协助诊断,本组11例中行胰十二指肠切除2例,胰体尾加脾切除6例,肿瘤单纯切除2例,囊肿-空肠袢式吻合1例,手术切除率为90.9%,术后1例死于腹内感染并峰主血症术后存活的10例均获随访（100%）。1例胰腺囊腺瘤手术后3个月死于心肌梗死,1例胰腺囊腺癌术后4年3个月死于癌转移,其余均健在,结论 凡中青年女性,上腹或左上腹出现较大肿块,且病程较长。结合B超和CT检查可对本病的诊断,胰腺囊腺瘤或囊腺癌,癌体虽较大,均有完整的包膜,而易于分离切除,首选手术方式为包括部分胰腺组织的全肿瘤切除术,疗效满意。     

Second primary carcinoma in the gastric tube constructed as an esophageal substitute after esophagectomy

BACKGROUND: The prognosis of esophageal carcinoma has improved, but along with this improvement, concern has increased about the occurrence of second primary carcinoma, especially gastric carcinoma, in tubes constructed from the stomach after esophagectomy. We describe our experience in the diagnosis and treatment of gastric tube carcinoma. STUDY DESIGN: We retrospectively examined 31 cases of gastric tube carcinoma; these cases occurred in 26 patients who received esophagectomy between September 1968 and October 2000. RESULTS: Surgical resection was performed in 10 patients. Gastrectomy with regional lymph node dissection was performed in 7 patients and partial resection of the stomach without lymph node dissection in 3 patients. In 6 patients leakage was encountered after gastrectomy; 3 of these patients died of multiple organ failure. Only one of the gastrectomy patients is alive without disease. Over the past 7 years, 15 patients with 20 lesions have been treated by endoscopic mucosal resection (EMR). Three of these patients required additional operation because of massive submucosal invasion by the tumor. One complication occurred at EMR, but it was successfully treated by conservative therapy. All patients treated by EMR alone were alive with neither local nor distant metastasis during a median followup period of 27.5 months. Of those patients who received surgical resection initially and were diagnosed as inoperable, all 10 had not received periodic checkups and had some symptoms. In contrast, of 15 patients who underwent EMR, all 20 lesions were found by annual followup endoscopic examination in the absence of symptoms. CONCLUSIONS: EMR for gastric tube carcinoma is safe and has few complications, in contrast to surgical resection of the gastric tube, which places a severe burden on the patient and has high morbidity and mortality. Early detection of the tumor by annual endoscopic examination is recommended for achieving good outcomes in gastric tube carcinoma after esophagectomy.     

胃癌肝转移31例外科治疗体会

目的 探讨胃癌肝转移的外科治疗效果.方法 对我院1997年10月～2006年10月收治的原发性胃癌338例中伴肝转移的31例的临床资料进行回顾性分析.对其中施行同时性胃癌肝转移灶切除术(切除组)的19例和仅行胃癌根治术而未行肝转移灶切除术(未切除组)的12例的术后生存时间进行对比.结果 全组除1例术后死于肝功能衰竭外,其余30例均获得随访.胃癌肝转移灶切除术后1年、3年和5年生存率分别为83.3%、44.4%和33.3%;未切除组术后1年生存率为50.0%,3年及5年生存率为0.两组术后生存时间有显著性差异(P＜0.05).切除组病例中有68.4%在肿瘤和周围肝组织间形成纤维假膜.结论 假包膜形成是有利的预后因素.对于胃癌肝转移病人,特别是有假包膜形成者采用外科治疗预后更好.     

腹腔镜胃局部切除术的临床应用

目的 评价腹腔镜胃局部切除术的临床应用价值.方法 回顾性分析2006年2月至2010年1月解放军总医院收治的78例行腹腔镜胃局部切除术患者的临床资料.根据病灶的位置和游离范围,采用全腹腔镜下胃局部楔形切除术、腹腔镜辅助下胃局部切除术和腹腔镜联合内镜切割吻合器肿瘤切除术.探讨患者的手术疗效.结果 78例患者均在腹腔镜下成功完成胃局部切除手术,无一例中转开腹.其中,45例行全腹腔镜胃局部楔形切除术,22例采用腹腔镜辅助下胃局部切除术,11采用腹腔镜联合内镜切割吻合器肿瘤切除术.平均手术时间为75 min(45～120 min),术中平均出血量为60 ml(35～90 ml),切除病灶平均直径为(2.5±1.3)cm(0.7～4.8 cm).术后患者无并发症发生及死亡.术后肠道功能平均恢复时间为35 h(25～42 h),术后平均住院时间为7.5 d(6～9 d).术后病理检查:63例患者为胃间质瘤;11例患者为胃良性疾病,其中异位胰腺组织5例、炎性假瘤2例、增生性息肉2例、神经鞘瘤1例、血管瘤1例;4例患者为类癌,其中位于黏膜层3例、累及深肌层1例.本组患者中位随访时间为26个月,未发现术后出血、吻合口狭窄及戳孔种植.63例胃间质瘤患者中,2例术后行甲磺酸伊马替尼治疗、1例肿瘤复发行再次手术治疗,术后恢复良好.结论 腹腔镜胃局部切除术治疗胃良性疾病、胃间质瘤及早期胃癌安全、可行.

Abstract：

Objective To evaluate laparoscopic local resection for the treatment of gastric tumors. Methods The clinical data of 78 patients who received laparoscopic local resection at the PLA General Hospital from February 2006 to January 2010 were retrospectively analyzed. According to the tumor site and free range, total laparoscopic gastrectomy was applied to 45 patients, laparoscopic local resection was applied to 22 patients, laparoscopic and endoscopic tumor resection was applied to 11 patients. The efficacies of the surgical approaches were investigated. Results Laparoscopic local resection was successfully performed on the 78 patients without conversion to open surgery. The mean operation time and operative blood loss were 75 minutes (range, 45-120 minutes) and 60 ml (range, 35-90 ml), respectively. The mean diameter of the tumor was (2.5±1.3)cm (range, 0.7-4.8 cm). No mortality or morbidity occurred postoperatively. The bowel function recovery time and the duration of hospital stay were 35 hours (range, 25-42 hours) and 7.5 days (range, 6-9 days), respectively. The results of postoperative pathological examination verified that 63 patients were with gastric stromal tumor, 11 patients were with benign gastric diseases, including 5 with gastric heterotopic pancreas, 2 with inflammatory pseudotumor, 2 with hyperplastic polyp, 1 with schwannomas and one with angioma. Four patients were with carcinoid, 3 carcinoids were located in mucous layer and 1 invaded into muscular layer. The median time of follow-up was 26 months, and no anastomotic stenosis or port-site metastasis was observed. Of the 63 patients with gastric stromal tumor, 2 were treated with imatinib mesylate, 1 had tumor recurrence and received reoperation. Conclusion Laparoscopic local resection is safe and feasible for the treatment of benign gastric neoplasms, stromal tumor and early gastric tumors.