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.

Diagnosis and Surgical Treatment of Pancreatic Gastrinoma in 13 Cases

Objective To investigate the diagnosis and treatment of pancreatic gastrinoma.Methods The clinical data of 13 patients with pancreatic gastrinoma who were admitted to Hainan Provincial People’s Hospital from Jan.1990 to Dec.2010 were retrospectively analyzed.Etiologic and localization diagnosis were preformed preoperatively according to the manifestation and the results of color Doppler ultrasound and computer tomography,respectively.All patients received chemoradiotherapy after operation according to the pathology results.Results All of the thirteen patients underwent operation.The location of pancreatic gastrinoma was found in the head of the pancreas in 9 cases,in the tail of the pancreas in 1 case,in the body of the pancreas in 2 cases,and 1 case with multiple pancreatic gastrinonma,respectively.The diameters of the pancreatic gastrinoma were 0.2-4.0 cm and 11 patiens were above 2.0 cm.One patient underwent resection of the body and tail of the pancreas and spleen,seven patients underwent tumor resection,two patients underwent resection of the choledocho-pancreatic junction,and three patients underwent pancreaticoduodenectomy.One patient complicated with pancreatic leakage and two with incision infection.Twelve patients were followed up for 16-120 months(mean 78 months).Clinical symptoms such as diarrhea disappeared after operation in twelve patients.Results of electronic gastroscopy in 6 months after continuous treatment with proton pump inhibition agents showed that the gastric ulcer were healed,the 12 hour gastric juice volume and the level of the gastric acid were in the normal range.Ten patients were cured,but one patient died because of other disease in 1 year after operation,one patient died because of recurrence in 1.5 years after operation,and one patient died in 4 years after reoperation of liver metastases.Conclusion Surgical treatment is a effective method for pancreatic gastrinoma.