胰腺神经内分泌肿瘤的腹腔镜治疗分析

摘要

Objective:To discuss the clinical efficacy of totally laparoscopic surgery for pancreatic neuroendocrine neoplasms (pNENs).Methods:The clinical data of 5 patients who were scheduled for laparoscopic surgery of pNENs from Jun.2014 to Jun.2017 were retrospectively analyzed.3 males and 2 females were enrolled in this study,with a median age of 53 years (range 32 to 62 years).3 cases got nonfunctional pNENs,in which two cases got clinical symptom of abdominal distension and one had no symptom;2 cases got functional pNENs (insulinoma) with symptom of recurrent attacks of hypoglycemia.The course of disease ranged from one week to 5 years.Results:Laparoscopic treatment of pNENs was successfully performed in 5 patients.The diagnosis of pNENs was confirmed by pathology for all the cases.The operative time was 65-420 min.The intraoperative blood loss was 50 (20,700) ml,only one case accepted blood transfusion.The postoperative hospital stay was (6.4±2.3) d.Two patients got postoperative pancreatic biochemical fistula and were cured by conservative treatment.Postoperative hemorrhage or abdominal infection was not found in any cases.Conclusions:Totally laparoscopic surgery is a safe,efficient and minimally invasive procedure for nonfunctional pNENs with quick recovery.And with accurate localization before and during operation,it is also a suitable method for functional pNENs.%目的:探讨胰腺神经内分泌肿瘤的腹腔镜治疗方法及效果.方法:2014年6月至2017年6月采用完全腹腔镜手术治疗胰腺神经内分泌肿瘤5例,其中男3例,女2例,患者32～62岁.无功能胰腺神经内分泌肿瘤3例,2例表现为腹部不适,1例无症状;功能性胰腺神经内分泌肿瘤2例,均为胰岛素瘤,表现为反复发作的低血糖症状.病程1周～5年.结果:5例均成功施行完全腹腔镜胰腺神经内分泌肿瘤切除术,术后经病理证实符合胰腺神经内分泌肿瘤.手术时间65～420 min,出血量50(20,700) ml,输血1例.术后平均住院(6.4±2.3) d.术后胰腺生化瘘2例,经保守治疗后痊愈.无术后出血、腹腔感染等严重并发症发生.结论:腹腔镜手术治疗无功能性胰腺神经内分泌肿瘤具有创伤小、康复快的优点,是安全、有效的治疗方法.对于功能性胰腺神经内分泌肿瘤,在术前、术中精准定位的基础上,也可选择腹腔镜手术治疗.