胰腺囊性病变的诊治:附36例报告

Diagnosis and treatment of pancreatic cystic diseases:a report of 36 cases

目的探讨胰腺囊性病变的诊断和手术治疗。方法对2002年1月1日～2009年1月1日期间我院收治的36例胰腺囊性病变患者的临床资料进行回顾性分析,复习文献,总结其诊断和治疗。结果 36例患者中只有4例主诉有上腹部不适非特异性症状,7例表现为腹部包块。6例胰腺假性囊肿均无胰腺炎病史,4例经B超或CT诊断为囊性肿瘤可能性大,剩余2例诊断为囊腺瘤;其它30例患者影像学检查均提示胰腺囊性肿瘤。病理结果胰腺假性囊肿6例,胰腺浆液性囊腺瘤l5例,黏液性囊腺瘤8例,胰腺导管内乳头状黏液性肿瘤4例,胰腺实性假乳头状瘤3例。所有患者均接受手术治疗,其中12例行胰十二指肠切除术,9例行胰体尾切除术,2例行腹腔镜下胰尾切除术,6例行胰腺肿瘤摘除术,7例行胰腺节段切除术。结论胰腺囊性病变临床表现不典型,不同的影像学检查对胰腺囊性病变的诊断有不同的指导意义。合理的手术是治疗胰腺囊性病变的重要手段。

Objective To discuss the diagnosis and surgical treatment of pancreatic cystic disease.Methods The clinical data of 36 patients with pancreatic cystic diseases who received surgical treatment in our hospital from January.2002 to January.2009 were retrospectively analyzed.Results Among 36 cases,only 4 had complaint of abdominal discomfort,and 7 presented with abdominal palpable mass.Six cases with pancreatic pseudocyst had no history of pancreatitis,of which 4 cases were suspected of and 2 misdiagnosed as cystic neoplasms through ultrasound and CT scan.The other 30 cases were all diagnosed as pancreatic cystic neoplasms.All patients underwent operations including pancreaticoduodenectomy in 12 cases,distal pancreatectomy in 9,laparoscopic distal pancreatectomy in 2,middle segment resection in 7,and tumor enucleation in 6 cases.Postoperative pathological results revealed pancreatic pseudocyst in 6 cases,serous cystic neoplasm in 15,mucinous cystic neoplasm in 8,intraductal papillary mucinous neoplasm in 4,and solid pseudopapillary tumor of the pancreas in 3 cases.Conclusions Pancreatic cystic diseases have no typical clinical manifestations.Different imaging methods play different roles in the diagnosis of pancreatic cystic diseases.Proper surgical operation is the main treatment for pancreatic cystic diseases.