摘要
目的探讨胰岛细胞瘤的诊断和外科治疗方法。方法回顾性分析2001年7月至2010年7月湘雅医院普外科收治的37例胰岛细胞瘤的临床资料。结果 37例中胰岛素瘤26例,胃泌素瘤2例,胰高血糖素瘤1例,无功能性胰岛细胞瘤8例。术前B超、CT、MRI诊断的阳性率分别为24.3%(9/37)、48.0%(12/25)、53.8%(7/13);术中B超(IOUS)诊断的阳性率为90.9%(10/11)。肿瘤单发者33例,位于胰头8例,胰颈体10例,胰尾15例;多发者3例,2例2个均位于胰体部,1例3个分别位于胰体(1个)和胰尾(2个)。肿瘤大小在0.5～7cm之间,直径≤2cm者27个,直径在2～5cm之间的11个,直径>5cm者2个。肿瘤局部摘除术22例,单纯胰体尾切除术5例,胰体尾切除术+脾切除术3例,胰十二指肠切除术5例,2例因发现肝脏转移灶及广泛腹腔淋巴结肿大,仅行活检术。术后并发症有胰瘘7例,肠梗阻2例,切口感染2例,本组无围手术期死亡病例。结论胰岛细胞瘤术前定性及术中定位很重要;术中触诊联合IOUS是定位的最有效方法;肿瘤摘除术是良性肿瘤的主要手术方式。恶性病变应积极行根治性手术。
Objective To discuss the diagnosis and surgical treatment of islet cell tumors（ICT）.Methods Clinical data of 37 cases of ICT treated in Xiangya Hospital between July 2001 and July 2010 were retrospectively analyzed.Results Of the 37 patients,26 had insulinoma,2 had gastrinoma,1 had glucagonoma and 8 had nonfunctional islet cell tumor（NFIT）.The positive rate was 24.3%（9/37） for ultrasonography,48.0%（12/25） for CT and 53.8%（7/13） for MRI before operation,respectively.The localization rate was 90.9%（10/11） for ultrasonography（IOUS） during operation.Solitary tumors were found in 33 patients（tumors in caput pancreatis in 8,in pancreatic neck and body in 10 and in pancreatic tail in 15）.Multiple tumors were found in 3 patients（2 tumors in pancreatic body in 2,and 1 tumor in pancreatic body and 2 tumors in pancreatic tail in 1）.Tumor size ranged from 0.5 to 7 cm.Tumor diameter was 2 cm or above in 27 tumors,2 to 5 cm in 11 and above 5 cm in 2.Local tumor excision was performed in 22 patients,distal pancreatectomy in 5 patients,distal pancreatectomy plus splenectomy in 3 patients,pancreaticoduodenectomy in 5 patients,and biopsy was performed in 2 patients who had liver metastases and extensive abdominal lymph nodes.Postoperative pancreatic fistula occurred in 7 cases,intestinal obstruction in 2 cases and wound infection in 2 cases,and no perioperative deaths occurred in all patients.Conclusion Preoperative qualitative diagnosis and intraoperative localization should be emphasized in ICT.Furthermore,intraoperative palpation combined with IOUS is effective for tumor location.Tumor excision is the main method for benign ICT,but radical surgery should be performed for malignant tumors.
出处
《实用临床医学（江西）》
CAS
2012年第1期47-50,共4页
Practical Clinical Medicine
关键词
胰岛细胞瘤
诊断
治疗
islet cell tumors
diagnosis
treatment
