无功能性恶性胰岛细胞瘤的诊治分析

目的:探讨无功能性恶性胰岛细胞瘤的诊断和治疗方法.方法:回顾分析自1993年6月至2006年3月收治的13例无功能性恶性胰岛细胞瘤患者资料.结果:13例无功能性恶性胰岛细胞瘤患者中男3例,女10例,中位年龄32.3岁,表现为上腹部无痛性包块(46.1%)和腹部饱胀不适(38.5%),位于胰头部8例(61.5%),胰体尾部肿瘤4例,胰头颈部1例.肿瘤平均最大径8.1cm,术前CT及MRI的定位准确率较高.13例患者均接受手术治疗,胰头十二指肠切除术6例、脾、胰体尾切除术3例、胰体尾切除术2例、活检 胆道内引流术1例,1例仅做活检.术后1年生存率为92.3%,3年生存率为73.8%,5年生存率为59.1%.结论:手术切除是治疗无功能性恶性胰岛细胞瘤的首选治疗方法,术后配合化疗有望提高其生存率.

Diagnosis and Therapy of Nonfunctioning Islet Cell Carcinoma of the Pancreas

Objective: To explore the diagnosis of nonfunctioning islet cell carcinoma(NFICC) of the pancreas,and to suggest proper management.Method: From Jun.1993 to Mar.2006,the medical records of 13 patients with the diagnosis of nonfunctioning islet cell carcinoma of the pancreas were retrospectively analyzed with respect to patient characteristics,characteristics of neoplasms,imaging features,surgical procedures,and long-term outcomes.Result: The median age of the patients(3 males and 10 females) was 32.3 years.The presenting symptoms of patients with NFICC were non-specific,abdominal painless mass(46.1%) and distentsion(38.5%) were the most frequent symptoms.Tumors with a median size of 8.1 cm were noted in the head of the pancreas in 8 patients,in the body or in the tail of the pancreas in 4 patients and in the head&neck of the pancreas in 1 patient.CT and MRI may play an important role in detecting and localizing the lesion before the operation.Among the 13 patients,pancreaticoduodenectomy was performed in 6 cases,resction of the spleen and pancreatic body-tail in 3 cases,resection of pancreatic body-tail in 2 cases,biopsy and biliary-enterostomy in 1 case and biopsy only in 1case.The 1,3 and 5-year survival rate of 13 patients were 92.3%,73.8% and 59.1% respectively.Conclusion: Surgical resection should be performed in patients with nonfunctioning islet cell carcinoma of the pancreas,and curative resection should be attempted for a good prognosis.In case of recurrence or metastases,repeated resections,chemotherapy,and hepatic artery chemoembolization lead to relief of symptoms and prolonged survival.