小儿胰腺恶性肿瘤11例诊治分析

Diagnosis and Treatment Analysis of Pancreatic Malignant Tumors in 11 Children

目的探讨小儿胰腺恶性肿瘤的临床特征和诊治方法。方法选取1992年7月-2004年5月收治的11例小儿胰腺恶性肿瘤。男5例,女6例;年龄3～14岁。7例患儿表现为腹痛,5例表现为腹部包块;其他症状包括黄疸3例,呕吐、厌食和发热各2例。11例患儿中,5例行胰十二指肠切除术,3例行脾及胰体尾切除术,2例行肿瘤局部切除术,1例仅行病理活检术,并对3例患儿分别给予化疗或放疗。结果11例患儿病灶术前至少一项影像学检查定位于胰腺,3例术前B超误诊为后腹膜肿块;术中探查可见5例患儿肿瘤位于胰体部,3位于胰头体部,2例位于胰尾部,1例位于胰头部;瘤体直径4～12cm,平均长径约6.5cm;肿瘤主要侵犯十二指肠和脾脏,均无远处转移。肿瘤类型包括囊实性乳头状肿瘤4例,胰母细胞瘤3例,无功能胰腺内分泌肿瘤2例,腺泡细胞癌及不典型胰腺类癌瘤各1例。术后随访2个月～9a,4例死亡,7例健在,其中1例复发后行胰头部和十二指肠切除处理。结论儿童胰腺恶性肿瘤少见,类型多样,完整切除后能长期生存,预后较成人好,但存在复发的可能,同时化疗和放疗的效果还不确定。

Objective To explore the diagosis and treatment and clinical features of pancreatic malignant tumors in children.Methods Eleven children with pancreatic malignant tumors（from Jul.1992 to May 2004） were collected,they were identified including 5 male and 6 female with the age of 3-14 years.The clinical manifestations were abdominal pain in 7 cases,abdominal mass in 5 cases,jaundice in 3 cases,emesis in 2 cases,fastidium in 2 cases and fever in 2 cases.Of the 11 patients,5 cases underwent pancreaticoduodenectomy,3 cases underwent resection of spleen,body and tail,2 cases received local resection,1 case received only biopsy,meanwhile,3 patients were treated by chemotherapy or radiotherapy.Results The tumor was location confirmed in pancreas before operation by imaging examination at least one,and 3 patients were misdiagnosed as retroperitoneal tumors by ultrasound.The tumor was located at pancreas body in 5 cases,3 cases at head of and body,2 cases at tail and 1 case at head.The size of tumor was different from each other,with the average length of 6.5 cm;the location of invasion involved duodenum and spleen,and there were no distant metastasis.The pathologic types were inclulded 4 cases of solid pseudopapillary tumor,3 cases of pancreatoblastoma,2 cases of nonfunctioning pancreatic endocrine tumors,1 case of acinar cell carcinoma,1 case of non-typical pancreatic carcinoid tumour.The chief complaints were palpable mass and abdominal pain,and the tumors were mainly located in the head and body of the pancreas.All patients were followed up for 2 months to 9 years respectively,and 4 cases died,7 cases were still alive,and 1 case underwent resection of head of pancreas and duodenum after recurrence.Conclusions Pancreatic malignant tumors in children are rare,and the histologiccal features are complex.Long survive is possible after complete resection,prognosis in children is better than those of adults with pancreatic cancer.However,the risk of recurrence is high.The roles of chemotherapy and radiation remain undefined.