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目的探讨胰血管活性肠肽瘤(VIPoma)诊断和治疗方法。方法报告中国医科大学附属第一医院2010年2月收治1例VIPoma的临床资料,并检索国内1993年1月至2009年12月间文献报道的24例。对25例VIPoma临床表现、实验室检查、影像学检查、手术方式及随访资料进行分析。结果有记载的24例中22例有周期性发作的水样泻;22例检测血清钾,21例有低钾血症。13例血浆血管活性肠肽(vasoactive intestinal peptide,VIP)测定均高于正常。行B超检查15例中13例发现病变,10例病变于胰腺内。行CT检查22例中18例胰腺内发现病变,其中7例发现肝脏转移性病灶。25例中24例行手术治疗,行胰体尾切除术13例中11例术前有水样泻,术后7例水样泻消失,1例好转,另3例无记载。行肿瘤摘除术3例中1例术后水样泻消失,1例明显好转。1例胰头部VIPoma并发肝转移,行扩大的胰十二指肠切除术后水样泻消失。行胰体尾切除术13例,获得远期随访8例,随访3个月至3.5年,1例术后3个月大出血死亡,1例术后3.5年复发、肝转移,另6例无复发。结论 VIPoma诊断依赖于典型的临床症状和血浆VIP测定;B超及CT是胰腺VIPoma定位诊断的可靠方法。手术切除为胰腺VIPoma有效治疗手段,即使是姑息性切除亦可改善病人生活质量,延长存活时间。
Objective To investigate the diagnosis and treatment of pancreatic vasoactive intestinal peptide tumor (VIPoma). Methods The clinical data of one case of VIPoma admitted to the First Affiliated Hospital of China Medical University in February 2010 were retrieved and retrieved from 24 cases reported in the literature from January 1993 to December 2009 in China. 25 cases of VIPoma clinical manifestations, laboratory tests, imaging studies, surgical methods and follow-up data were analyzed. Results Of the 24 documented cases, 22 had recurrent episodes of watery diarrhea; 22 had serum potassium detected and 21 had hypokalemia. Thirteen patients with vasoactive intestinal peptide (VIP) were measured higher than normal. Line B ultrasound examination of 15 cases found lesions in 13 cases, 10 lesions in the pancreas. In 22 cases of CT examination, 18 cases of lesions were found in the pancreas and 7 cases of liver metastases were found. Twenty-five of 25 patients underwent surgical treatment. Of the 13 patients who underwent pancreatic ductal tail resection, 11 had preoperative watery diarrhea, and 7 had watery diarrhea disappeared after operation. One patient improved and the other 3 patients had no records. Three cases of tumor resection in one case of water-based diarrhea disappeared, 1 case was significantly improved. One case of VIPoma with hepatic metastasis of the head of the pancreas disappeared after the extended pancreatoduodenectomy. Thirteen patients underwent pancreatic body tail resection and long-term follow-up were obtained. Eight patients were followed up for 3 months to 3.5 years. One patient died of major hemorrhage 3 months after operation. One patient recurred 3.5 years after operation, and liver metastases. The other 6 patients had no recurrence . Conclusion The diagnosis of VIPoma depends on the typical clinical symptoms and plasma VIP. B-ultrasound and CT are reliable methods for the diagnosis of pancreatic VIPoma. Surgery for the treatment of VIPoma pancreas effective, even palliative resection can improve the quality of life of patients and prolong survival time.