胰腺内分泌肿瘤的诊断和外科治疗

目的：探讨胰腺内分泌肿瘤（pancreatic endocrine tumours, PET）的临床特点，藉以提高临床诊治水平。方法：对我院1973年1月至2006年12月收治的77例PET患者的临床、病理资料进行回顾性分析。结果：本组女性46例（59.7%）；功能性PET占72.7%；良性为81.8%。术前B超和CT检查发现65例（84.4%）有胰腺占位病变；单发肿瘤位于胰头、体、尾部，分别为18.2%、28.6%和45.5%；多发肿瘤6例。肿瘤最大径8 cm。所有病例均得到病理检查，显示胰岛素瘤43例（55.8%），胃泌素瘤7例，胰高血糖素瘤5例，血管活性肠肽瘤1例，余21例为无功能PET。2例胃泌素瘤合并甲状旁腺瘤，为Ⅰ型多发性內分泌瘤。胰高血糖素瘤表现为游走性坏死性红斑、大泡性皮损和糖尿病。血管活性肠肽瘤表现为腹泻和低钾血症；无功能PET主要症状为反复中上腹隐痛。手术治疗PET的主要术式为肿瘤局部切除术（53例，68.8%）。手术后43例胰岛素瘤患者中，39例血糖恢复正常；胃泌素瘤、胰高血糖素瘤和血管活性肠肽瘤患者的术后症状均有缓解或完全消失。胰漏是主要的术后并发症。结论：PET发病隐匿,根据B超和CT检查可明确肿瘤的位置。最终诊断根据病理检查。本病预后明显好于胰腺癌，因此一旦明确诊断，应争取彻底切除肿瘤。恶性PET伴转移者的术后病死率较高。

Diagnosis and surgical treatment of pancreatic endocrine tumours

Objective： To investigate the diagnosis and surgical treatment of pancreatic endocrine tumours （PET）. Methods：The clinical data of 77 cases with PET from 1973 to 2006 in our hospital were analyzed retrospectively. Results： Forty-six （59.7%） cases were female. The functional PET accounted for 72.7% and benign 81.8%. Sixty-five （84.4%） cases were diagnosed as pancreatic lesions by CT and ultrasonography preoperatively. The single lesion was located at head （18.2%）, body （28.6%） and tail （45.5%） of pancreas and 6 cases had multiple PET. The diameter of the largest tumor was 8 cm. All of 77 cases were identified by pathological examination, of which 43 （55.8%） cases were insulinoma, 7 cases gastrinoma, 5 cases glucagonoma, 1 case vipoma and 21 cases nonfunctional PET. Two cases with gastrinoma complicated parathyroidoma were diagnosed as multiple endocrine neoplasia type 1 （MEN1）. The patients with glucagonoma experienced diabetes and skin damage. Vipoma patient had diarrhea and kaliopenia. Nonfunctioning PET cases showed upper abdominal pain. The mainway for the surgical treatment of PET was local tumor resection. Blood glucose was returned to normal postoperatively in 39 of 43 cases with insulinoma. The postoperative symptoms of the patients with gastrinoma, glucagonoma and vipoma disappeared or relieved at some extent. Pancreatic leakage was the main postoperative complication. Conclusions： The onset of PET conceals. The location of PET may be identiifed with ultrasonography and CT. The ifnal diagnosis depends on pathological examination. The prognosis of PET is better than that of pancreatic cancer obviously. Therefore the best selection to treat PET is to resect the lesion completely when the diagnosis is set up. However malignant PET with metastasis has higher postoperative mortality.