中国实用外科杂志

中国实用外科杂志

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无功能性胰腺神经内分泌肿瘤外科治疗

戴梦华，王文倩   

  1. 中国医学科学院北京协和医院基本外科，北京100730
  • 出版日期:2019-09-01 发布日期:2019-09-12

  • Online:2019-09-01 Published:2019-09-12

摘要：

随着影像学技术的发展和常规体检的普及，无功能性胰腺神经内分泌肿瘤（NF-pNENs）的检出率逐年升高。世界卫生组织（WHO）分级标准、欧洲神经内分泌肿瘤学会(ENETS)及美国癌症联合委员会(AJCC)分期系统为目前临床常用的分期系统（G分期），可作为判断预后的独立影响因素。根据G分期将NF-pNENs肿瘤分为良性，低度恶性和恶性肿瘤，对于不同分期，手术指征及治疗方法完全不同。淋巴结转移与肿瘤的位置、大小、淋巴血管侵犯及Ki-67密切相关，而淋巴结转移预示肿瘤术后早期复发和转移，术前了解淋巴结是否存在转移对手术方式的选择具有指导意义。超声引导下肿瘤穿刺技术的进步为术前病理分期及淋巴结转移提供了更加敏感的指标。国内外指南一致认为肿瘤大小是决定是否手术的关键。对于直径＜2 cm、惰性生长、未见恶性征象、无临床症状的NF-pNENs，可选择定期复查；对于直径＞2 cm的肿瘤，即便出现局部血管及器官侵犯，也应积极行常规术式的胰腺切除术。对所有接受手术的病人，均应行淋巴结采样或清扫术。对于合并肝转移的病人，可根据转移灶情况选择根治性手术切除、介入治疗或肝移植术

关键词: 无功能性胰腺神经内分泌肿瘤, 外科治疗

Abstract:

Surgical treatment of non-functional pancreatic neuroendocrine neoplasms        DAI Meng-hua, WANG Wen-qian. Department of General Surgery, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing 100730,China
Corresponding author：DAI Meng-hua, E-mail：daim66@126.com
Abstract    The incidence of non-functional pancreatic neuroendocrine neoplasms（NF-pNENs） constantly increases due to the development of imaging techniques and the popularity of routine medical examination. WHO classification system，ENETS and AJCC grading systems，widely used in clinical practice，are independent prognostic factors. According to the G grading system，NF-pNENs are classified into benign，low-grade malignant and high-grade malignant tumors. Operative indications and treatments are absolutely different for each subgroup. Lymph node metastasis closely correlates with the position and size of tumor，lymphovascular invasion and Ki-67 index. Pre-operative determination of the presence of lymph node metastasis provides significant instructions for the choice of surgery since it indicates early tumor relapse and metastasis. The advance of ultrasound-guide biopsy provides more sensitive indictors for pre-operative pathological grade and lymph node metastasis. Both domestic and foreign guidelines consider the tumor size as the critical factors for surgery. For those NF-pNENs＜2 cm，indolent growth pattern，without malignant signs and clinical symptoms，an intensive follow-up is recommended. For those tumors＞2 cm，even with local vascular and organs invasion，a routine pancreatic surgery is recommended （distal pancreatectomy or pancreatic duodenectomy according to the tumor position）. Lymph node sampling or regional lymphadenectomy should be routinely performed during surgeries. For those with liver metastasis，surgical resection，locoregional ablative therapy or liver transplantation is suggested according to the situation of metastatic sites.

Key words: non-functional pancreatic neuroendocrine neoplasms, surgical treatment