36例胰腺浆液性囊腺瘤的临床分析

The clinical analysis of thirty-six pancreatic serous cystadenoma

目的:探讨胰腺浆液性囊腺瘤的诊断和治疗。方法:对1998年6月至2006年9月瑞金医院收治的36例病理诊断为胰腺浆液性囊腺瘤的临床资料进行回顾性分析。结果:胰腺浆液性囊腺瘤好发于中老年女性,多见于胰腺头颈部,无特征性临床表现。B超和CT诊断囊性肿瘤的正确率分别为69%(25/36)和94%(34/36)。CT对于囊腺瘤的诊断正确率为80%(29/36),对浆液性囊腺瘤的诊断正确率为61%(22/36)。在不能排除或考虑实性假乳头状瘤的病人中MRI对于囊腺瘤的诊断正确率80%(4/5)。本组35例行手术治疗,其中7例行胰十二指肠切除;11例行胰腺节段切除;12例行胰体尾切除;5例行局部切除,1例行剖腹探查活组织检查。10例术后出现并发症,包括胰瘘、内出血、幽门梗阻、胰腺假性囊肿合并肠瘘病人及不同程度的胸腔积液。1例因内出血死亡。本组3例失访,32例获随访,除2例因其它疾病死亡,其余均健在,术后无复发。结论:CT和MRI,结合肿瘤学指标和临床病理特征可大大提高浆液性囊腺瘤的术前诊断率。浆液性囊腺瘤是一种良性的肿瘤,但手术治疗并发症较多。大多数浆液性囊腺瘤可考虑随访;有症状的胰腺浆液性囊腺瘤,或与黏液性囊性肿瘤不能鉴别者,应手术治疗。

Objective To investigate the diagnosis and treatment of pancreatic serous cystadenoma（PSC）. Methods The clinical data of 36 patients with pancreatic serous cystadenoma confirmed by pathology treated in ruijin hospital affiliated with medical college,shanghai jiaotong university from June 1998 to September 2006 were retrospectively analyzed. Results PSC predominantly occurred in middle-old aged women, mainly situated in the head and isthmus of pancreas, and its clinical manifestation were often nonspecific.Ultrasound and CT correctly diagnosed 69%（25136） and 94%（34/36） of all the patients respectively for pancreatic cystic tumor. CT correctly diagnosed 80% of all cases for cystadenoma, 61%（22/ 36） for serous cystadenoma.While magnetic resonance imaging correctly diagnosed 80%（4/5） of cases which was considered solid-pseudopapillary tumor or could not be differenciated as serous cystadenoma or solid-pseudopapillary tumor of the pancreas.35 patients were treated surgically. Pancreaticoduodenectomy was performed in 7 patients, segmental pancreatectomy in 11 ,body-distal pancreatectomy in 12,and 5 enucleation were carried out.Another one patient underwent ex- ploratory laparotomy with a diagnostic biopsy. Complications were found in 10 cases in postoperative period ,pancreatic fis- tula in 10 cases, internal hemorrhage in 2, pyloric obstruction in 2, pancreatic pseudocyst together with intestinal fistula in l.Pleural effusion with different degree were found in all 10 cases with complications.Except one patient died for internal hemorrhage, all other patients recovery after treatment.Thirty-two patients were followed up.0f the 32 patients, 2 died for other causes and 30 are currently alive without postoperative recurrence of PSC. Conclusions CT and MRI,combined with tumor marker and clinicopathologic features, improved diagnostic accuracy consumedly for PSC.PSC is a completely benign cystic neoplasms of the pancreas, although surgical resection could cure it as well as cause many serious complications.Therefore follow-up could be considered in most of the patients with serous cystadenoma.Surgical resection is indicated only when the tumor is symptomatic or could not be differentiated from a mucinous cystic neoplasms.