胰腺神经内分泌肿瘤的外科治疗
胰腺神经内分泌肿瘤( PNEN)分为功能性和无功能性两大类,根治性手术是治愈肿瘤和争取患者长期生存的唯一有效手段。局部可切除肿瘤首选手术切除,手术方式包括局部切除(剜除)术和规则性胰腺切除术。胰岛素瘤和直径小于2 cm无功能性PNEN可行局部切除(剜除)术、保留脾脏的胰体尾切除术或节段胰腺切除术;直径2 cm及以上或恶性倾向PNEN应行根治性切除术,同时附加区域淋巴结清扫术,包括胰十二指肠切除术、胰体尾切除术及中段胰腺切除术等。对于局部进展无法根治切除病变,功能性PNEN可以选择减瘤术,尽量切除90%以上的肿瘤,包括转移灶和原发灶;无功能性PNEN患者出现黄疸、消化道梗阻和出血等并发症时,可考...
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Published in | Zhejiang da xue xue bao. Journal of Zhejiang University. Medical sciences. Yi xue ban Vol. 45; no. 1; pp. 31 - 35 |
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Main Author | |
Format | Journal Article |
Language | Chinese English |
Published |
南京医科大学第一附属医院胰腺中心,江苏南京,210029
25.01.2016
Beijing Zhongke Journal Publising Co. Ltd |
Subjects | |
Online Access | Get full text |
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Summary: | 胰腺神经内分泌肿瘤( PNEN)分为功能性和无功能性两大类,根治性手术是治愈肿瘤和争取患者长期生存的唯一有效手段。局部可切除肿瘤首选手术切除,手术方式包括局部切除(剜除)术和规则性胰腺切除术。胰岛素瘤和直径小于2 cm无功能性PNEN可行局部切除(剜除)术、保留脾脏的胰体尾切除术或节段胰腺切除术;直径2 cm及以上或恶性倾向PNEN应行根治性切除术,同时附加区域淋巴结清扫术,包括胰十二指肠切除术、胰体尾切除术及中段胰腺切除术等。对于局部进展无法根治切除病变,功能性PNEN可以选择减瘤术,尽量切除90%以上的肿瘤,包括转移灶和原发灶;无功能性PNEN患者出现黄疸、消化道梗阻和出血等并发症时,可考虑行肿瘤原发灶切除。肝脏是PNEN最常见远处转移部位,可分为Ⅰ、Ⅱ、Ⅲ型。对Ⅰ型PNEN患者,只要无手术禁忌应建议手术切除。对Ⅱ型PNEN患者如考虑行减瘤术,应尽可能切除全部肝转移灶的90%;对原发灶已切除且不伴有肝外远处转移、分化好( G1/G2)的患者,肝移植可以作为一种治疗选择。对无法切除的Ⅲ型PNEN患者,可选择多种辅助治疗方法。 |
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Bibliography: | 33-1248/R Pancreatic neoplasms/surgery;Neuroendocrine tumors/surgery WU Junli, GUO Feng, WEI Jishu, LU Zipeng, CHEN Jianmin, GAO Wentao, LI Qiang, JIANG Kuirong, DAI Cuncai, MIAO Yi (Pancreas Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China) Pancreatic neuroendocrine neoplasmas ( PNENs ) are classified into functioning &non-functioning tumors.The radical surgery is the only effective way for the cure & long-term survival.For the locoregional resectable tumors, the surgical resection is the first choice of treatment;the surgical procedures include local resection ( enucleation) and standard resection.For the insulinomas and non-functioning tumors less than 2 cm, local resection ( enucleation ) , distal pancreatectomy with spleen-preservation or segmental pancreatectomy are the commonly selected procedures.The radical resections with regional lymph nodes dissection, including pancreaticoduodenectomy, distal pancreatectomy and middle segmental pancreatectom junliwu1973@hotmail.com第一作者:吴峻立(1973-), 男, 博士, 主任医师, 副教授, 硕士生导师, 主要从事胰腺肿瘤的基础和临床研究; E-mail:; http://orcid.org/0000-0002-6946-0510 |
ISSN: | 1008-9292 |
DOI: | 10.3785/j.issn.1008-9292.2016.01.05 |