功能保留性胰腺手术治疗胰腺神经内分泌肿瘤患者疗效和预后研究*

目的 研究采用功能保留性胰腺手术治疗胰腺神经内分泌肿瘤患者的疗效及预后情况。方法 2014年3月~2017年2月我科诊治的67例胰腺神经内分泌肿瘤患者,行功能保留性胰腺手术治疗者33例被设为研究组,行传统手术治疗者34例被设为对照组。在研究组,在腔镜下行肿瘤局部切除术8例、中段胰腺切除术（MSP）11例和保留幽门的胰十二指肠切除术（PPPD）14例。采用ELISA法检测血清胰高血糖素、胃泌素、生长抑素和胰岛素。结果 研究组手术时间为（163.7±21.3） min,显著短于对照组【（179.4±20.8） min,P<0.01】,术中出血量为（267.8±36.1） ml,显著少于对照组【（315.2±35.6） ml,P<0.01】,肛门排气时间为（22.4±6.2） h,显著短于对照组【（29.1±6.5） h,P<0.01】,术后住院时间为（6.9±1.4）d,显著短于对照组【（7.5±1.2） d,P<0.05】;术后1 w,研究组血清胰高血糖素水平为（134.9±44.8） ng/L,显著低于对照组【（175.3±44.2） ng/L,P<0.01】,血清胃泌素水平为（354.6±62.7） pg/L,显著低于对照组 【（435.9±63.3） pg/L,P<0.01】,而血清生长抑素水平为（59.0±5.4） ng/L,显著高于对照组 【（42.1±5.8） ng/L,P<0.01】,血清胰岛素水平为（9.8±1.5） μU/ml,显著高于对照组 【（7.6±1.4） μU/ml,P<0.01】;研究组新发糖尿病、胃肠吻合口瘘、胃排空功能障碍、腹腔感染和门静脉血栓形成等并发症发生率为12.1%,显著低于对照组的26.5%（P<0.05）;在随访1年末,两组肿瘤复发率无显著性差异（9.1%对17.6%,P>0.05）。结论 采用功能保留性胰腺手术治疗胰腺神经内分泌肿瘤患者可以相对维持胰腺的内分泌功能,减少术后并发症的发生,促进患者早日康复。

Shor-term efficacy of laparoscopic functional retention operation in patients with pancreatic neuroendocrineneoplasm

Objective To investigate the short-term efficacy of laparoscopic functional retention operation in patients with pancreatic neuroendocrineneoplasm（PNENs）. Methods A total of 67 patients with PNENs were recruited in our hospital between March 2014 and February 2017,and 33 patients received laparoscopic pancreatic functional retention surgery serving as observation group,and out of them,local tumor resection was conducted in 8,middle segment pancreatectomy （MSP） in 11 and pylorus preserving pancreaticoduode nectomy （PPPD in 14 patients,and 34 patients were operated by traditional surgery serving as the control group. Serum glucagon,gastrin,somatostatin and insulin levels were detected by ELISA. Results In the observation group, the operative time was significantly shorter than that in the control group （163.7±21.3） min vs. （179.4±20.8） min,P<0.01], the amount of intraoperative blood loss was significantly less than in the control group （267.8±36.1） ml vs. （315.2±35.6） ml,P<0.01],the anal venting time was significantly shorter than that in the control group （22.4±6.2） h vs.（29.1±6.5） h,P<0.01] and the post-operational stay was significantly shorter than that in the control group （6.9±1.4） d vs. （7.5±1.2） days,P<0.05];at the end of 1 week post-operation,serum glucagon levels was （134.9±44.8） ng/L,much lower than （175.3±44.2）ng/L,P<0.01],serum gastrin level was （354.6±62.7） pg/L,muchi lower than （435.9±63.3） pg/L,P<0.01],while serum somatostatin level was（59.0±5.4） ng/L,significantly higher （42.1±5.8） ng/L,P<0.01],and serum insulin level was （9.8±1.5） μU/ml,significantly higher （7.6±1.4） μU/ml,P<0.01] in the control;the incidences of complications, such as new diabetes, gastrointestinal anastomotic fistula, gastric emptying dysfunction, infection, and portal thrombosis was 12.1%,much lower than 26.5% （P<0.05） in the control and at the end of one year followed-up, the tumor recurrence was not significantly different between the two groups （9.1% vs. 17.6%,P>0.05）. Conclusion Laparoscopic functional retention pancreatic surgery might be preserve the pancreatic functions in patients with PNENs with less post-operational complications and improve early recovery of the patients.