胰腺囊性肿瘤的诊治98例报告

Diagnosis and surgical treatment of pancreatic cystic tumors:Analysis of 98 cases

目的探讨胰腺囊性肿瘤的常见类型、诊断及合理手术方式的选择。方法对2000年1月至2008年12月期间收治98例胰腺囊性肿瘤患者的临床资料进行回顾性分析。结果本病无特征性的临床表现,B超、CT和MRI等影像学检查也能发现胰腺囊肿病灶但不能确定具体类型。本组胰腺囊腺瘤57例(浆液性囊腺瘤32例,黏液性囊腺瘤25例),黏液性囊腺癌13例,实性假乳头状瘤19例,导管内乳头状黏液性肿瘤9例。所有患者均手术治疗,胰十二指肠切除26例,保留十二指肠胰头切除28例,胰腺节段切除术7例,胰体尾切除加脾脏切除25例,肿瘤摘除术12例。术后均进行随访,3例胰腺囊腺癌患者于术后6个月到4年期间死于癌转移或其他疾病,1例囊腺癌患者术后9个月肿瘤复发,再次手术后现仍生存,其他均存活。结论B超,CT和MRI等影像学技术是胰腺囊性肿瘤的主要诊断方法。手术切除为治疗该肿瘤的最有效手段。正确的诊断和合理手术方式的选择是提高其临床治愈率的关键。

Objective To assess the common types, diagnosis and surgical option of pancreatic cystic tumors. Methods From January 2000 to December 2008, 98 patients with pancreatic cystic tumors in our center were reviewed retrospectively. Results Pancreatic cystic tumor had no specific clinical manifestations. B ultrasound, CT and MRI could found the pancreas cystic lesions but could not determine the specific type. Of the 98 patients, 57 patients had pancreatic cystoadenoma including serous cystadenoma（ 32 patients） and mucinous cystadenoma （25） ; 13 patients had mucinous cystadenocarcinoma; 19 patients had pancreatic solid pseudopapillary tumor; and 9 patients had intraductal papillary mucinous tumors. All patients received surgical treatment, pancreato-duodenectomy was performed in 26 patients, duodenum-preserving pancreatic head resection in 28, segmental resection of the pancreas in 7 , distal pancrectomy in 25, and single tumorectomy in 12. All patients were followed up; 3 patients with cystadenocarcinoma died from tumor metastasis or other diseases within 6 months to 4 years after surgery, 1 patient with recurrent tumor after 9 months survived after reoperation, and others were alive. Conclusions B ultrasound, CT and MRI are the main diagnostic methods of pancreatic cystic tumors. Surgery is the most effective method for the treatment of pancreatic cystic tumors. And correct diagnosis and reasonable surgical option are the key to raise the cure rate.