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浙江大学学报(医学版)  2016, Vol. 45 Issue (1): 31-35    DOI: 10.3785/j.issn.1008-9292.2016.01.05
神经内分泌肿瘤专题     
胰腺神经内分泌肿瘤的外科治疗
吴峻立, 郭峰, 卫积书, 陆子鹏, 陈建敏, 高文涛, 李强, 蒋奎荣, 戴存才, 苗毅
南京医科大学第一附属医院胰腺中心, 江苏 南京 210029
Surgical treatment for pancreatic neuroendocrine neoplasmas
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
全文: PDF(815 KB)  
摘要: 

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。

关键词 胰腺肿瘤/外科学神经内分泌瘤/外科学    
Abstract

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 pancreatectomy, should be applied for tumors more than 2 cm or malignant ones. For the locoregional advanced or unresectable functioning tumors, debulking surgery should be performed and more than 90% of the lesions including primary and metastatic tumors should be removed; for the non-functioning tumors, if complicated with biliary & digestive tract obstruction or hemorrhage, the primary tumors should be resected. The liver is the most frequent site of metastases for PNENs and three types of metastases are defined. For typeⅠmetastasis, patients are recommended for surgery if there are no contraindications; For type II metastasis, debulking surgery should be applied and at least 90% of metastatic lesions should be resected, and for patients with primary tumors removed and no extrahepatic metastases, or for patients with well-differentiated (G1/G2) tumors, liver transplantation may be indicated. For the unresectable type Ⅲ metastasis, multiple adjuvant therapies should be chosen.

Key wordsPancreatic neoplasms/surgery    Neuroendocrine tumors/surgery
收稿日期: 2015-12-20     
CLC:  R73  
基金资助:

国家自然科学基金(81273536)

通讯作者: 苗毅(1954-),男,博士,主任医师,教授,博士生导师,主要从事胰腺疾病的基础和临床研究;E-mail:miaoyi@njmu.edu.cn;http://orcid.org/0000-0003-2542-8663     E-mail: miaoyi@njmu.edu.cn
作者简介: 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:junliwu1973@hotmail.com;http://orcid.org/0000-0002-6946-0510
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引用本文:

吴峻立 等. 胰腺神经内分泌肿瘤的外科治疗[J]. 浙江大学学报(医学版), 2016, 45(1): 31-35.
WU Junli, GUO Feng, WEI Jishu, LU Zipeng, CHEN Jianmin, GAO Wentao, LI Qiang, JIANG Kuirong, DAI Cuncai, MIAO Yi. Surgical treatment for pancreatic neuroendocrine neoplasmas. Journal of ZheJiang University(Medical Science), 2016, 45(1): 31-35.

链接本文:

http://www.zjujournals.com/xueshu/med/CN/10.3785/j.issn.1008-9292.2016.01.05      或      http://www.zjujournals.com/xueshu/med/CN/Y2016/V45/I1/31

[1] STROSBERG J, GARDNER N, KVOLS L. Survival and prognostic factor analysis of 146 metastatic neuroendocrine tumors of the mid-gut[J]. Neuroendocrinology, 2009, 89(4):471-476.
[2] HASHIM Y M, TRINKAUS K M, LINEHAN D C, et al. Regional lymphadenectomyis indicated in the surgical treatment of pancreatic neuroendocrine tumors (PNETs)[J]. Ann Surg, 2014, 259(2):197-203.
[3] 中华医学会外科学分会胰腺外科学组.胰腺神经内分泌肿瘤治疗指南(2014)[J]. 中国实用外科杂志, 2014, 34(12):1117-1119. Pancreatic Surgical Group, Surgical Branch, Chinese Medical Association. Guidelines of treatment for pancreatic neuroendocrine tumors[J]. Chinese Journal of Practical Surgery, 2014, 34(12):1117-1119. (in Chinese)
[4] LEE L C, GRANT C S, SALOMAO D R, et al. Small, nonfunctioning, asymptomatic pancreatic neuroendocrine tumors (PNETs):role for nonoperative management[J]. Surgery, 2012, 152(6):965-974.
[5] CASADEI R,RICCI C,REGA D,et a1.Pancreatic endocrine tumors less than 4 cm in diameter:resect or enucleation? a single-center experience[J]. Pancreas, 2010,39(6):825-828.
[6] 奚春华,苗毅,戴存才,等. 胰腺内分泌肿瘤的外科治疗[J].胰腺病学, 2006, 6(4):211-215. XI Chunhua, MIAO Yi, DAI Cuncai, et al. Surgical treatment for pancreatic neuroendocrine tumors[J]. Chinese Journal of Pancreatology, 2006, 6(4):211-215. (in Chinese)
[7] 郭峰,徐泽宽,钱祝银,等. 肿瘤局部切除治疗胰腺神经内分泌肿瘤的临床应用[J].中华内分泌外科杂志, 2013, 7(6):491-493. GUO Feng, XU Zekuan, QIAN Zhuyin, et al. Local resection for the treatment of pancreatic neuroendocrine tumors[J]. Chinese Journal of Endocrine Surgery, 2013, 7(6):491-493. (in Chinese)
[8] AKERSTRÖM G,HELLMAN P.Surgery on neuroendocrine tumours[J]. Best Pract Res Clin Endocrinol Metab, 2007,21(1):87-109.
[9] LACONO C, VERLATO G, RUZZENENTE A, et al. Systematic review of central pancreatectomy "the dagradi-serio-lacono operation"and meta-analysis of central versus distal pancreatectomy[J]. Gastroenterology, 2011, 140(Suppl 1):S1038-S1039.
[10] GLAZER E S, TSENG J F, AL-REFAIE W, et al. Long-term survival after surgical management of neuroendocrine hepatic metastases[J]. HPB(Oxford), 2010, 12(6):427-433.
[11] JONES N B, SHAH M H, BLOOMSTON M, et al. Liver-directed therapies in patients with advanced neuroendocrine tumors[J]. J Natl Compr Canc Netw, 2012, 10(6):765-774.
[12] BONINSEGNA L, PANZUTO F, PARTELLI S, et al. Malignant pancreatic neuroendocrine tumour:lymph node ratio and Ki67 are predictors of recurrence after curative resections[J]. Eur J Cancer, 2012, 48(11):1608-1615.
[13] LESURTEL M, NAGORNEY D M, MAZZAFERRO V, et al. When should a liver resection be performed in patients with liver metastases from neuroendocrine tumours? a systematic review with practice recommendations[J]. HPB, 2015, 17(1):17-22.
[14] SAXENA A, CHUA T C, PERERA M, et al. Surgical resection of hepatic metastases from neuroendocrine neoplasms:a systematic review[J]. Surg Oncol, 2012, 21(3):e131-e141.
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