无功能性胰岛细胞瘤的管理
Management of nonfunctioning islet cell tumors.
作者信息
Liang Han, Wang Pu, Wang Xiao-Na, Wang Jia-Cang, Hao Xi-Shan
机构信息
Department of Gastrointestinal Oncological Surgery, Tianjin Cancer Hospital, Tianjin Medical University, Hexi District, Tianjin 300060, China.
出版信息
World J Gastroenterol. 2004 Jun 15;10(12):1806-9. doi: 10.3748/wjg.v10.i12.1806.
AIM
To more clearly define the clinical and pathological characteristics and appropriate diagnosis and treatment of nonfunctioning (NFICTs) islet cell tumors, and to review our institutional experience over the last 30 years.
METHODS
The records of 43 patients confirmed to have nonfunctioning islet cell tumors of pancreas were retrospectively reviewed. Survival was estimated by the Kaplan-Meier methods and potential risk factors for survival were compared with the log-rank tests.
RESULTS
The mean age was 31.63 years (range, 8 to 67 years). There were 7 men and 36 women. Twenty-eight patients had a confirmed diagnosis of nonfunctioning islet cell carcinoma (NFICC) and benign islet cell tumors were found in 15 patients. The most common symptoms in patients with NFICTs were abdominal pain (55.8%), nausea and/or vomiting (32.6%), fatigue (25.6%) and abdominal mass (23.3%). Preoperative ultrasonic and computed tomography localized the tumors in all patients. Forty-three NFICTs were distributed throughout the pancreas, with 21 located to the right of the superior mesenteric vessels, 10 in the body of the pancreas, 6 in the tail of the pancreas, and multiple tumors were found in one patient. Thirty-nine of 43 patients (91%) underwent surgical resection. Surgical treatment was curative in 30 patients (70%) and palliative in 9(21%). The resectability and curative resection rate in patients with NFICC of pancreas were 89% and 61%, respectively. The overall cumulative 5- and 10-year survival rates for patients with NFICC were 58.05% and 29.03%, respectively. Radical operation and diameter of cancer small than 10 cm were positive prognostic factors in females younger than 30 years old. Multivariate Cox regression analysis indicated that radical operation was the only independent prognostic factor, P=0.007.
CONCLUSION
Nonfunctioning islet cell tumors of pancreas are found mainly in young women. The long-term results for patients undergone surgery, especially curative resection are good.
目的
更清晰地界定无功能性胰岛细胞瘤（NFICTs）的临床和病理特征以及合适的诊断与治疗方法，并回顾我院过去30年的经验。
方法
对43例确诊为胰腺无功能性胰岛细胞瘤的患者记录进行回顾性分析。采用Kaplan-Meier法估计生存率，并通过对数秩检验比较生存的潜在危险因素。
结果
平均年龄为31.63岁（范围8至67岁）。男性7例，女性36例。28例确诊为无功能性胰岛细胞癌（NFICC），15例为良性胰岛细胞瘤。NFICTs患者最常见的症状为腹痛（55.8%）、恶心和/或呕吐（32.6%）、乏力（25.6%）和腹部肿块（23.3%）。术前超声和计算机断层扫描对所有患者的肿瘤进行了定位。43个NFICTs分布于整个胰腺，其中21个位于肠系膜上血管右侧，10个位于胰体部，6个位于胰尾部，1例患者为多发肿瘤。43例患者中有39例（91%）接受了手术切除。手术治疗对30例患者（70%）有效，9例（21%）为姑息性治疗。胰腺NFICC患者的可切除率和根治性切除率分别为89%和61%。NFICC患者总的累积生存率在5年和10年时分别为58.05%和29.03%。根治性手术和癌灶直径小于10 cm是30岁以下女性的良好预后因素。多因素Cox回归分析表明，根治性手术是唯一独立的预后因素，P = 0.007。
结论
胰腺无功能性胰岛细胞瘤主要见于年轻女性。接受手术治疗的患者，尤其是根治性切除患者的长期效果良好。
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