本文選題：胰腺神經內分泌腫瘤 + VIP瘤�。� 參考：《大連醫(yī)科大學》2017年碩士論文

【摘要】：目的:總結胰腺神經內分泌腫瘤(Pancreatic neuroendocrine tumors,PNETs)患者的臨床資料以及復習國內外相關文獻,對其發(fā)病規(guī)律、臨床表現、病理學特征、治療及預后情況進行分析探討,旨在提高臨床醫(yī)師對此類疾病的認識,促進胰腺神經內分泌腫瘤診療水平的提高。材料及方法:回顧性分析大連醫(yī)科大學附屬第一醫(yī)院及附屬第二醫(yī)院2007年1月至2016年6月的36例胰腺神經內分泌腫瘤患者的臨床及病理資料,利用統(tǒng)計學軟件,對其發(fā)病規(guī)律、臨床表現、實驗室檢查結果、病理特征、診療方法以及預后相關因素等進行回顧性研究。結果:1、女性23人,男性13人,男女比例約為1:1.77;年齡分布15-73歲,平均年齡46.1 ±16歲,中位年齡47.5歲。2、無功能性PNETs24例(66.7%),其中偶然發(fā)現的腫瘤13例,其余表現為腹痛、惡心、食欲不振、黃疸等非特異性癥狀;功能性PNETs12例(33.3%),其中胰島素瘤11例,血管活性腸肽瘤(VIP瘤)1例;胰島素瘤患者主要表現為低血糖的相關癥狀,如心慌、心率加快、頭暈、嗜睡、意識障礙、易饑餓、四肢抽搐、行為異常等;VIP瘤患者有明顯消瘦、低鉀血癥、嚴重腹瀉。3、行B超檢查26例,腫瘤檢出率65.4%;行上腹CT檢查29例,檢出率96.6%;行上腹MRI檢查25例,檢出率100%,3例患者行PETCT檢查,均發(fā)現胰腺腫物。腫瘤發(fā)生在胰頭12例,發(fā)生在胰體尾24例。術前檢查發(fā)現肝臟轉移2例。4、35例行手術治療,單純腫物切除術14例(40.0%),胰十二指腸切除術5例(14.3%),胰體尾切除6例(17.1%),胰體尾+脾切除術7例(20%),胰腺中段切除+胰腸吻合術3例(8.6%),1例患者術前行穿刺活檢病理證實為胰腺神經內分泌腫瘤且有肝臟轉移,拒絕行手術治療后出院。術后主要并發(fā)癥為胰瘺。5、術后病理腫瘤直徑0.8-7.Ocm,平均3.2± 1.8cm,中位大小2.5cm,其中功能性PNETs平均直徑1.7±0.6cm,無功能性PNETs平均直徑3.9± 1.8cm。術后證實淋巴結轉移5例。33例患者可行WHO分級,G1、G2、G3級分別為13例(39.4%)、19例(57.6%)、1例(3.0%)。術后病理行CgA免疫組化染色32例,陽性率84.4%,行syn染色33例,陽性率90.9%。6、35例獲得隨訪,2例患者死亡,1例因腫瘤廣泛轉移,1例G3級患者死于心血管疾病,其余患者仍生存,且無腫瘤復發(fā)和轉移。結論:胰腺神經內分泌腫瘤為一種少見的低度惡性胰腺腫瘤,功能性PNETs多有特異性的臨床表現,無功能性PNETs多數無明顯癥狀,部分具有非特異性的臨床表現。功能性PNETs腫瘤直徑一般小于無功能性PNETs;功能性PNETs多發(fā)生于年齡較大患者。影像學檢查是重要的診斷手段,B超檢出率較低,CT和MRI檢出率較高。手術切除是PNETs患者的首選治療方法,應根據腫物位置、直徑、有無轉移來確定手術方式,術后的主要并發(fā)癥是胰瘺。Syn和CgA是常用的免疫組化指標,具有較高的特異性和敏感性。PNETs總體預后較好,但仍需密切隨訪。
[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 鹵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 鹵1.8 cm) and the median size was 2.5 cm. The mean diameter of functional PNETs was 1.7 鹵0.6 cm, and that of non-functional PNETs was 3.9 鹵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.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.9

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本文編號：2017077