无功能性胰腺神经内分泌肿瘤的临床诊治分析

李婧; 王琳; 康强; 李越华; 朱红; 陈怡璇; 雷学芬

doi:10.12259/j.issn.2095-610X.S20230706

无功能性胰腺神经内分泌肿瘤的临床诊治分析

doi: 10.12259/j.issn.2095-610X.S20230706

李婧¹,
王琳¹,
康强¹,
李越华¹,
朱红¹,
陈怡璇²,
雷学芬^2, ,

1.
昆明医科大学第二附属医院肝胆胰外科
2.
肿瘤科，云南昆明　650101

基金项目: 国家自然科学基金资助项目（81860423）；云南省科技厅-昆明医科大学应用基础研究联合专项基金面上项目（2019FE001-071）

详细信息

作者简介:
李婧（1994～），女，纳西族，云南大理人，医学硕士，住院医师，主要从事神经内分泌肿瘤的诊治工作

通讯作者:
雷学芬，E-mail ：leixuefen@kmmu.edu.cn

中图分类号: R735.9
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- 被引次数: 0
出版历程
- 收稿日期: 2023-05-23
- 网络出版日期: 2023-07-17
- 刊出日期: 2023-07-25

Analysis of Clinical Diagnosis and Treatment of Nonfunctional Pancreatic Neuroendocrine Neoplasms

1.
Dept. of Hepatopancreatobiliary Surgery
2.
Dept. of Oncology，The 2nd Affiliated Hospital of Kunming Medical University，Kunming Yunnan 650101，China

摘要

摘要: 目的探讨手术切除对无功能性胰腺神经内分泌肿瘤（nonfunctioning pancreatic neuroendocrine neoplasms，NF-pNENs）患者预后的影响。方法回顾性分析2011年1月至2020年12月就诊于昆明医科大学第二附属医院的45例经术后病理确诊为NF-pNENs患者的临床及随访资料。结果随访时间为6～112个月，中位随访时间47个月，获得随访的患者有43例，术后有1例复发、2例远处转移，存活40例，死亡3例，1例分化良好的G2患者术后83个月因全身多发转移死亡，2例分化差的 G3患者于术后6个月死亡。NF-pNENs患者术后5 a生存率为95.3%。结论手术作为目前唯一能治愈pNENs的手段，在专业的胰腺中心是可行的，术前明确WHO分级和淋巴结是否转移有利于手术方式的选择，术中需要进行规范的淋巴结清扫获得足够数目的淋巴结来明确转移情况，才能更好地指导预后评价。
- 胰腺神经内分泌肿瘤 /
- 手术 /
- 疗效
Abstract: Objective To investigate the prognosis of surgical resection in patients with nonfunctioning pancreatic neuroendocrine neoplasms （NF-pNENs）. Methods The clinical and follow-up data of 45 patients who were pathologically confirmed NF-pNENs in the Second Affiliated Hospital of Kunming Medical University from January 2011 to December 2020 were retrospectively analyzed. Results The follow-up time was 6 to 112 months, and the median follow-up time was 47 months. A total of 43 patients were followed up. Postoperative recurrence occurred in 1 case, distant metastasis in 2 cases, 40 cases survived, and 3 cases died, one well-differentiated G2 patient died 83 months after surgery due to multiple systemic metastasis, and two poorly differentiated G3 patients died 6 months after surgery. The 5-year postoperative survival rate of patients with NF-pNENs was 95.3%. Univariate analysis showed that the tumor WHO grade and lymph node metastasis were related to the prognosis of NF-pNENs patients, and the difference was statistically significant （P < 0.05）. Multivariate analysis did not suggest independent factors affecting the prognosis of NF-pNENs. Conclusions Surgery is the only cure for pNENs currently, which is available in specialized pancreatic centers. Preoperative identification of WHO grade and lymph node metastasis is conducive to the choice of surgical mode. Standard intraoperative lymph node dissection is required to obtain a sufficient number of lymph nodes to clarify the metastasis, so as to better guide the prognostic evaluation.
- Pancreatic neuroendocrine neoplasms /
- Surgery /
- Curative effect

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图 1 pNENs CT表现

A：平扫时A胰颈部出现2.5 cm×2.0 cm大小的等密度影；B：增强扫描时动脉期表现为“富血供”肿瘤。

Figure 1. pNENs CT performance

下载: 全尺寸图片幻灯片

图 2 胰体尾+脾切除患者术后46个月出现肝脏多发转移

A：肝脏大小不一的转移灶；B：最大的转移灶位于肝左右叶交界处；C：经肝动脉造影显示肝内多个团块状转移瘤病灶。

Figure 2. Multiple liver metastases were observed 46 months after pancreatococcygeal and splenectomy

下载: 全尺寸图片幻灯片

图 3 45例NF-pNENs患者生存曲线（月）

Figure 3. Survival curves of 45 patients with NF-pNENs （months）

下载: 全尺寸图片幻灯片

参考文献(17)

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