胰腺实性假乳头状瘤27例诊疗分析

Clinical analysis of solid-pseudopapillary tumor of the pancreas in 27 cases

目的总结胰腺实性假乳头状瘤的诊断和治疗经验。方法对2000年9月至2007年6月收治的27例胰腺实性假乳头状瘤病例进行回顾性分析。结果27例患者中女性26例，男性1例，中位年龄26岁。上腹部疼痛不适16例，腹部无痛性包块11例，肿瘤标记物均无异常。B超表现为回声不均囊实性病变或低回声实性病变，边界清楚，内部无血流信号。CT增强扫描呈高血供囊实性占位病变。MRI表现为T1低-中低信号，T2高-中高信号，边界清楚。9例行胰十二指肠切除术，4例行胰腺局部切除＋胰管空肠吻合术，6例行胰腺局部切除术，8例行胰体尾加脾切除术。术后病理12例为局限性病变，14例侵及周围胰腺组织，1例患者发现脉管瘤栓及淋巴结转移。平均随访26．1个月，均未发现肿瘤复发或转移。结论胰腺实性假乳头状瘤是一种多发于青年女性的低度恶性胰腺肿瘤，缺乏特征性临床表现，CT增强扫描具有相对特征性表现，完整切除肿瘤可获得良好预后。

Objective To summarize the experience in the diagnosis and treatment for solidpseudopapillary tumors of the pancreas （SPTP）. Method In this study, 27 cases of SPTP from September 2000 to June 2007 were retrospectively analyzed. Results The median age of these 27 cases was 26 years. There were 26 females and 1 male. Epigastric pain was complained in 16 cases, abdominal aponia mass in 11 cases. Tumour marker level was within normal range. Ultrasonic manifestation usually shows cystic and solid lesion without blood signal. Lesions were typical with high blood supply in enhanced CT scan, cystic and solid component confounding in it. MRI revealed low-middle signal in T1 and middle-high signal in T2. Pancreaticoduodenectomy was performed in 9 cases, pancreatic local excision and pancreaticojejunostomy were performed in 4 cases, pancreatic local excision was performed in 6 cases, Distal pancreatectomy and spleen resection were performed in 8 cases. Post-operative pathology shows local lesion in 12 cases, invading the pancreatic parenchyma in 14 cases and intravascular tumor thrombi and lympbnode metastasis in 1 case. All cases were followed up with an average period of 26.1 months. There was no recurrence nor metastasis. Conclusion Solid-pseudopapillary tumor of the pancreas has a low malignant potential, affecting primarily young women. It has no typical clinical appearance. Enhanced CT scanning has the relative characteristic imaging. Complete resection usually results in long-term survival.