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目的 探讨功能性胰腺内分泌肿瘤(PETs)的诊断和治疗方法.方法 回顾性分析1998年1月至2008年12月第三军医大学西南医院收治的45例功能性PETs患者的临床资料.术前根据临床表现进行定性诊断,以腹部彩色多普勒超声、CT等检查进行定位诊断.实施胰体尾+脾切除术8例,肿瘤摘除术32例,胆胰结合部切除术1例,胰十二指肠切除术4例.术后给予相应化疗.结果 45例患者中,良性34例,恶性11例.肿瘤位于胰头8例,胰尾26例,胰体7例,胰腺内多发肿瘤4例;肿瘤直径为0.3～5.0 cm,其中>2.0 cm者19例.术后8例患者出现胰液漏,2例发生切口感染,1例发生腹腔感染.33例胰岛素瘤患者中,5例多发肿瘤患者术后血糖未恢复正常,其中3例再次行手术治疗,2例口服胰岛素分泌抑制剂治疗,血糖均控制在正常范围;7例胃泌素瘤患者术后腹泻等临床症状消失,服用质子泵抑制剂治疗,半年后行电子胃镜检查示溃疡愈合,基础胃酸分泌及12 h胃液量均在正常范围;4例胰高血糖素瘤患者术后3周内坏死性游走性皮疹明显消失或明显减退,血氨基酸水平升高,糖尿病得以痊愈;1例恶性血管活性肠肽瘤患者术后腹泻、电解质紊乱得以纠正.45例患者中39例随访20～120个月,32例良性患者中2例复发,3例因其他疾病死亡;7例恶性患者中2例生存,3例因肝转移或肿瘤复发死亡,2例因其他疾病死亡.结论 外科治疗是功能性PETs有效的治疗方法.姑息性肿瘤切除术亦可明显改善患者的生命质量.

Objective To investigate the diagnosis and treatment of functional pancreatic endocrine tumors (PETs). Methods The clinical data of 45 patients with functional PETs who were admitted to the Southwest Hospital from January 1998 to December 2008 were retrospectively analyzed. Etiologic and localization diagnosis were made preoperatively according to the manifestation and the results of color doppler ultrasound and computed tomography, respectively. Eight patients received resection of the body and tail of the pancreas and spleen, 32 received tumor enucleation, one received resection of the pancreaticobiliary junction and four received pancreaticoduodenectomy. All patients received chemotherapy after the operation. Results Thirty-four cases of the PETs were benign and the rest eleven cases were malignant. Eight cases of the PETs were in the head of the pancreas,26 in the tail of the pancreas, seven in the body of the pancreas and four cases were with multiple PETs. The diameters of the PETs were 0. 3-5.0 cm, and the diameters of the PETs in 19 cases were above 2.0 cm. Eight patients were complicated with pancreatic leakage, two with incision infection and one with abdominal infection. Of the 33 patients with insulinoma, the blood glucose of five patients with multiple PETs was still abnormal after the operation, three patients underwent reoperation and the other two were treated by diazoxide to control the blood glucose in the normal range. The clinical symptoms of the seven patients with gastrinoma disappeared after the operation, and the gastric ulcer was healed, the 12-hour gastric juice volume and the level of the gastric acid were in the normal range after a continuous treatment with proton pump inhibition agents for 6 months. Necrotizing or migratory rash and diabetes of the four patients with glucagonoma were cured three weeks later, and the level of the amino acid was back to normal. Diarrhea and electronic disturbance of one patient with vasoactive intestinal peptide tumor were alleviated after the operation. Thirty-nine patients were followed up for 20-120 months. Of the 32 patients with benign PETs, two patients had tumor recurrence, and three patients died of other diseases. Of the seven patients with malignant PETs, two patients survived, and three patients died of hepatic metastasis or tumor recurrence, two patients died of other diseases. Conclusions Surgical treatment is effective for the treatment of functional PETs. Palliative resection of the tumor also can obviously improve the life quality of patients with fuctional PETs.