无功能胰岛细胞瘤的诊断和外科治疗

目的 总结无功能胰岛细胞瘤的诊断和外科治疗经验.方法 对1968年1月至2008年6月南京医科大学第一附属医院收治的44例无功能胰岛细胞瘤患者的临床资料进行回顾性分析.其中男性9例,女性35例,年龄7～70岁,平均40.1岁.临床表现:腹部包块15例(34.1%),上腹部及腰背部疼痛17例(38.6%),黄疸5例(11.4%),有上腹部饱胀、呕吐等消化道梗阻症状5例(11.4%),体检或行影像学检查发现胰腺占位性病变10例(22.7%).影像学检查:行CT检查33例(75.0%),B超检查16例(36.4%),逆行胰胆管造影检查6例(13.6%),磁共振成像检查2例(4.5%),上消化道钡餐10例(22.7%).手术方法:手术切除39例,切除率为88.6%.未行手术切除5例(11.4%).结果 并发症发生情况:胰瘘7例(15.9%),腹腔大出血4例(9.1%),胃肠吻合口梗阻1例(2.3%),胆瘘2例(4.5%),切口感染3例(6.8%).随访结果:1999年之前收治的患者随访8～60个月,手术死亡2例(4.5%),另有1例于术后15个月因脑血管意外死亡;1999年之后收治的患者随访6～108个月,除1例患者术后75个月不明原因死亡外,其余均健在.结论 无功能胰岛细胞瘤无特异性临床表现.多排螺旋增强CT是首选的影像学检查方法.外科手术是首选治疗手段,中段胰腺切除术已成为治疗胰腺头颈部无功能胰岛细胞瘤的又一选择.

Diagnosis and surgical treatment for non-functional islet cell tumor: a retrospective analysis of 44 cases

Objective To evaluate the methods of diagnosis and surgical treatment for nonfunctional islet cell tumor(NICT). Methods Forty-four patients with non-functional islet cell tumor treated at the First Affiliated Hospital of Nanjing Medical University during January 1968 to June 2008 were analyzed retrospectively. There were 9 males and 35 females,aged from 7 to 70 years old. Clinical manifestation: 15 cases( 34. 1% ) of abdominal masses, 17 patients ( 38. 6% ) with epigastrie or back pain, 5 cases of juandice, 5 cases (11.4%) for upper abdominal fullness or vomiting, 10 cases (22.7%) of pancreatic tumor noticed by routine health checkups or imaging examinations. Imaging examination: CT scan, sonography, ERCP, MRI, upper GI series were performed in 33 (75.0%), 16 ( 36. 4% ), 6 ( 13. 6% ), 2 (4. 5% ) ,and 10 cases (22. 7% )respectively. Operation methods:39 patients (88. 6% ) underwent surgical resection and the other 5 patients did not. Results Complications: pancreatic fistula in 7 patients (15.9%), intra-abdominal bleeding in 4 ( 9. 1% ), gastrojejunal anastomosis outlet obstruction in 1 (2. 3% ) ,biliary fistula in 2 (4. 5% ) and incisional infection in 3 (6. 8% ). Surgery related mortality happened in 2 patients (4. 5% ) ,both treated before 1999. Twenty-five patients underwent operation between January 1999 and June 2008 were followed up for 6 to 108 months. All survive except one died 75 months after the surgery for unkown reason. Conclusions No specfic clinical manifestation is recognized for non-functional islet cell tumor. Spiral CT is an optimal diagnotlc method, while surgery is the first choice for treatment. Middle segmental panereatectomy has become an alternative surgical protocol for NICT.