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Clinical Analysis of29Cases of Surgical Treatment of Pancreatic Endocrine Tumors

Author: MaDongWei
Tutor: GongPeng
School: Dalian Medical University
Course: Surgery
Keywords: pancreatic endocrine tumor pancreas islet cell tumor diagnosis surgical operation
CLC: R735.9
Type: Master's thesis
Year: 2012
Downloads: 2
Quote: 0
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Abstract


Objective: Pancreatic endocrine tumor (PET) is a kind of tumor that originatedfrom Langerhan cell proliferation in the pancreas islet. This rare kind of tumor accountsfor only2%to4%of the pancreatic tumor, with a population incidence ofapproximately1-5/100000. There were29cases of PET patients treated in the FirstAffiliated Hospital of Dalian Medical University between February2000and February2012. This paper is to do a retrospective analysis of the clinical manifestations,diagnosis and surgical treatment methods to pancreatic endocrine tumors (PET), in thepurpose of improving knowledge as well as diagnosis and treatment level of PET.Methods: A retrospective analysis of the29cases of PET treated between Feb.2000and Feb.2012in the First Affiliated Hospital of Dalian Medical University. Theaspects include the clinical manifestations, laboratory inspects, medical imaging,surgical methods, postoperative complications and prognosis were studied.Results: All the29patients went through surgery and postoperative pathologicaldiagnosis. Among these29cases,14of them are nonfunctioning pancreas islet celltumor (14/29,48.2%), of which9cases are benign (9/29,31.0%)and5cases aremalignant (5/29,17.2%);9cases are insulinoma (9/29,31.0%) with7benign (7/29,24.1%) and2malignant (2/29,6.9%);3cases are gastrinoma (3/29,10.2%) with1benign (1/29,3.4%) and2malignant (2/29,6.8%); both the2cases of glucagon tumorare malignant (2/29,6.8%); the other1case is malignant vasoactive intestinal peptidetumor (1/29,3.4%). There are17cases benign (58.6%) and12cases malignant (41.4%)in total of the29patients. All these29patients went through B-ultrasound scan and CTscan.17cases were found tumor by B-ultrasound scan (17/29, positive rate58.6%)while CT plain scan and enhanced scan showed26cases (26/29, positive rate89.6%).18of the19patients who went through MRI plain scan and enhanced scan revealed tumor (18/19, positive rate94.7%).11patients had endoscopic ultrasonographyexamination and10of them were detected of pancreatic tumor (positive rate90.9%).We have8cases with PET in pancreatic head,5of them were removed local tumor and3underwent pancreaticoduodenectomy. There are16cases with PET in the pancreatictail and9were removed local tumor,7underwent pancreatic tail resection plussplenectomy. There are3cases located outside the pancreas, and they were removedlocal tumor.2cases had multiple lesions, one was executed local tumor excision and theother pancreatic tail resection plus splenectomy.2cases were given intraoperativeduodenum longitudinal incision and11cases were given intraoperative ultrasoundexamination, while10were detected of tumor.3cases were given liver metastasesresection among5liver transfer cases.9cases had postoperative pancreatic fistula inthis group, with an incidence of31.0%.6of them were treated with local excision,2pancreatic tail resection and1case was given pancreaticoduodenectomy. Of all the29PET cases,2benign cases failed to follow-up, but we kept following up the rest27patients from4months to12years. All the15benign cases survived without recurrenceduring the follow-up, in contrast of the malignant cases with survival rate at91.4%(11/12) for one year and66.6%(8/12) for3years.Conclusion: Nonfunctioning islet cell tumor is in majority of all the29PET cases,and most of them are benign. The relevance ratio of PET by means of CT and MRIplain and enhanced examination is significantly higher than that by B-ultrasound scan.Endoscopic ultrasonography examination is a effective method to find the position ofPET. The most common postoperational complication is pancreatic fistula. Themalignancy ratio of PET is low, and patients may have a longer survival time than othertumor. Primary neoplasms and their metastasis should be resected to the best inoperation.

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CLC: > Medicine, health > Oncology > Gastrointestinal Cancer > Pancreatic tumors
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