36例胰腺神经内分泌肿瘤的临床诊治与分析

发布时间：2018-06-14 10:29

本文选题：胰腺神经内分泌肿瘤 + VIP瘤　；参考：《大连医科大学》2017年硕士论文

【摘要】：目的:总结胰腺神经内分泌肿瘤(Pancreatic neuroendocrine tumors,PNETs)患者的临床资料以及复习国内外相关文献,对其发病规律、临床表现、病理学特征、治疗及预后情况进行分析探讨,旨在提高临床医师对此类疾病的认识,促进胰腺神经内分泌肿瘤诊疗水平的提高。材料及方法:回顾性分析大连医科大学附属第一医院及附属第二医院2007年1月至2016年6月的36例胰腺神经内分泌肿瘤患者的临床及病理资料,利用统计学软件,对其发病规律、临床表现、实验室检查结果、病理特征、诊疗方法以及预后相关因素等进行回顾性研究。结果:1、女性23人,男性13人,男女比例约为1:1.77;年龄分布15-73岁,平均年龄46.1 ±16岁,中位年龄47.5岁。2、无功能性PNETs24例(66.7%),其中偶然发现的肿瘤13例,其余表现为腹痛、恶心、食欲不振、黄疸等非特异性症状;功能性PNETs12例(33.3%),其中胰岛素瘤11例,血管活性肠肽瘤(VIP瘤)1例;胰岛素瘤患者主要表现为低血糖的相关症状,如心慌、心率加快、头晕、嗜睡、意识障碍、易饥饿、四肢抽搐、行为异常等;VIP瘤患者有明显消瘦、低钾血症、严重腹泻。3、行B超检查26例,肿瘤检出率65.4%;行上腹CT检查29例,检出率96.6%;行上腹MRI检查25例,检出率100%,3例患者行PETCT检查,均发现胰腺肿物。肿瘤发生在胰头12例,发生在胰体尾24例。术前检查发现肝脏转移2例。4、35例行手术治疗,单纯肿物切除术14例(40.0%),胰十二指肠切除术5例(14.3%),胰体尾切除6例(17.1%),胰体尾+脾切除术7例(20%),胰腺中段切除+胰肠吻合术3例(8.6%),1例患者术前行穿刺活检病理证实为胰腺神经内分泌肿瘤且有肝脏转移,拒绝行手术治疗后出院。术后主要并发症为胰瘘。5、术后病理肿瘤直径0.8-7.Ocm,平均3.2± 1.8cm,中位大小2.5cm,其中功能性PNETs平均直径1.7±0.6cm,无功能性PNETs平均直径3.9± 1.8cm。术后证实淋巴结转移5例。33例患者可行WHO分级,G1、G2、G3级分别为13例(39.4%)、19例(57.6%)、1例(3.0%)。术后病理行CgA免疫组化染色32例,阳性率84.4%,行syn染色33例,阳性率90.9%。6、35例获得随访,2例患者死亡,1例因肿瘤广泛转移,1例G3级患者死于心血管疾病,其余患者仍生存,且无肿瘤复发和转移。结论:胰腺神经内分泌肿瘤为一种少见的低度恶性胰腺肿瘤,功能性PNETs多有特异性的临床表现,无功能性PNETs多数无明显症状,部分具有非特异性的临床表现。功能性PNETs肿瘤直径一般小于无功能性PNETs;功能性PNETs多发生于年龄较大患者。影像学检查是重要的诊断手段,B超检出率较低,CT和MRI检出率较高。手术切除是PNETs患者的首选治疗方法,应根据肿物位置、直径、有无转移来确定手术方式,术后的主要并发症是胰瘘。Syn和CgA是常用的免疫组化指标,具有较高的特异性和敏感性。PNETs总体预后较好,但仍需密切随访。
[Abstract]:Objective: to summarize the clinical data of patients with Pancreatic neuroendocrine tumors (PNETs) and to review the relevant literature at home and abroad, and to analyze the pathogenesis, clinical manifestations, pathological features, treatment and prognosis of Pancreatic neuroendocrine tumors. The aim of this paper is to improve clinicians' understanding of these diseases and to promote the diagnosis and treatment of pancreatic neuroendocrine tumors. Materials and methods: the clinical and pathological data of 36 patients with pancreatic neuroendocrine tumors from January 2007 to June 2016 in the first affiliated Hospital and the second affiliated Hospital of Dalian Medical University were retrospectively analyzed. Clinical manifestations, laboratory findings, pathological features, diagnosis and treatment methods and prognostic factors were retrospectively studied. Results among them, there were 23 females and 13 males, and the male / female ratio was about 1: 1.77; the age distribution was 15-73 years old, with an average age of 46.1 卤16 years, with a median age of 47.5 years. The median age was 47.5 years, and 24 cases of nonfunctional PNETs had 66.7% of them. Among them, 13 cases were found by chance, and the rest showed abdominal pain, nausea, and loss of appetite. Non-specific symptoms such as jaundice, 12 cases of functional PNETs, including 11 cases of insulinoma, 1 case of vasoactive intestinal peptisma and 1 case of VIP tumor, mainly showed hypoglycemia related symptoms, such as panic, rapid heart rate, dizziness, lethargy, disturbance of consciousness. Patients with VIP tumors such as hunger, limb convulsions, abnormal behavior and so on have obvious wasting, hypokalemia, severe diarrhea, and 26 cases of B ultrasound examination, the detection rate of tumor is 65.4%, 29 cases of upper abdomen CT examination, the detection rate of 96.6%, and 25 cases of upper abdominal MRI examination. The detectable rate was 100% and 3 cases were examined by PETCT, and all the pancreatic masses were found. Tumor occurred in 12 cases of pancreatic head and 24 cases of pancreatic body and tail. Preoperative examination revealed 2 cases of liver metastasis. 35 cases were treated by operation. Simple resection of tumor was performed in 14 cases, pancreatoduodenectomy in 5 cases, resection of body and tail in 6 cases, resection of body and tail of pancreas in 6 cases, resection of body and tail of pancreas in 7 cases, pancreaticoenterostomy in 3 cases, pancreatoenterostomy in 3 cases. Pancreatic neuroendocrine tumors with liver metastasis, He refused to undergo surgery and was discharged from hospital. The main postoperative complications were pancreatic fistula. The diameter of pathological tumor was 0.8-7.Ocm (mean 3.2 卤1.8 cm) and the median size was 2.5 cm. The mean diameter of functional PNETs was 1.7 卤0.6 cm, and that of non-functional PNETs was 3.9 卤1.8 cm. After operation, 5 cases of lymph node metastasis were confirmed. 33 cases were classified by WHO as 13 cases with G1 / G2G3 and 19 cases (57.6%) with G2G3 respectively. The positive rate of CGA immunohistochemical staining was 84.4% in 32 cases and syn staining was used in 33 cases. The positive rate was 90.9.60.35 cases were followed up. 1 case died of cardiovascular disease due to extensive metastasis of tumor, 1 case of G3 grade died of cardiovascular disease, and the other patients still survived. There was no recurrence or metastasis. Conclusion: pancreatic neuroendocrine tumor is a rare low grade malignant pancreatic tumor. Most of the functional PNETs have specific clinical manifestations, while most of the nonfunctional PNETs have no obvious symptoms, and some of them have nonspecific clinical manifestations. The tumor diameter of functional PNETs was generally smaller than that of nonfunctional PNETs, and functional PNETs mostly occurred in older patients. Imaging examination is an important means of diagnosis, B ultrasound detection rate is lower than CT and MRI detection rate is higher. Surgical resection is the first choice of treatment for PNETs. The main complications are pancreatic fistula, Syn and CGA, which should be determined according to the location, diameter and metastasis of the tumor. The overall prognosis of PNETs with high specificity and sensitivity is good, but should be followed up closely.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.9

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