胰腺实性假乳头状瘤的临床诊治策略:附13例报告

Diagnostic and therapeutic strategies of solid pseudopapillary tumor of the pancreas:report of 13 cases

目的探讨胰腺实性假乳头状瘤的临床病理特点与治疗方法。方法回顾性分析我院2000年5月至2011年3月诊治的13例胰腺实性假乳头状瘤病例的临床资料。结果 13例胰腺实性假乳头状瘤患者中女性12例,男性1例。发病年龄15～42岁,平均年龄29岁。患者血糖正常,无外伤和胰腺炎病史。肿瘤位于胰头3例,位于胰颈3例,位于胰体、尾7例。肿瘤直径3～9cm不等。13例患者均行手术治疗,术中探查均未发现腹腔或肝脏转移。其中肿物位于胰头部的2例行胰头、十二指肠切除术,位于胰、体尾部的4例行常规开腹胰体、尾切除术,1例行胰体尾联合脾脏切除术,1例行腔镜下胰体、尾切除术,其余5例行完整肿物切除术。术后均未行放、化疗等综合治疗。随访时间从2个月到60个月不等,未发现复发、转移,无死亡。结论胰腺实性假乳头状瘤术前诊断困难,最终诊断依赖于病理检查结果,其恶性度很低,很少发生周围浸润和远处转移。治疗首选在彻底切除肿瘤的前提下,最大可能保留患者脏器功能的手术方式。

Objective To study the clinicopathological characteristics of solid pseudopapillary tumor of the pancreas(SPTP)and its treatment modalities.Methods Clinical data of 13 SPTP patients treated in our hospital from May 2000 to March 2011 were retrospectively analyzed.Results There were 12 females and one male.The patients had normal blood glycemia,and no history of abdominal trauma and pancreatitis.The average age of the patients was 29 years with a range from 15 to 42 years.The tumors were located in pancreatic head in 3,pancreatic neck in 3,pancreatic body and tail in 7 patients with the tumor diameter ranging from 3cm to 9 cm.All the patients received surgical treatments including pancreaticoduodenectomy in 2,distal pancreatectomy in 4,and distal pancreatectomy plus spleen resection in one,complete tumor resection in 6 cases.No intra-peritoneal and liver metastases were found during laparotomy.No postoperative complications occurred except pancreatic fistula in one case.After follow-up from 2 to 60 months,there were no recurrence and metastasis.Conclusions Pre-operative diagnosis of SPTP is difficult,and its final diagnosis can be only confirmed by pathology.Function-preserving operation with complete resection of the primary tumor is proposed because of its excellent prognosis and low-grade malignancy with less surrounding invasion and metastasis.