胰腺囊性病变治疗方法选择

Selective approach to the therapy of cystic lesions of the pancreas

目的:探讨胰腺囊性病变患者治疗方法的选择。方法:回顾性分析127例根据影像学方法以及细针抽吸活检(FNA)诊断为胰腺囊性病变患者的治疗和随访情况。结果:48例患者(38%)初始选择手术治疗,79例患者(62%)初始选择影像学随访;40%(19例)初始手术治疗的患者经术后病理确诊存在恶性肿瘤或癌前病变,随访患者中有9例(11%)因病变有恶变倾向而行手术切除,术后病理确诊恶性肿瘤为3例(3.8%)。对于囊性病变直径<3cm、无实性占位且临床无症状的囊肿,在影像学随访中恶性转变危险<4%,与手术切除胰腺囊性病变死亡率相似。结论:对无实性占位、囊肿直径小、囊肿无分隔和无症状患者,可初始选择影像学随访。

Objective： To discuss the approach of treating the patients who suffered from cystic lesions of the pancreas. Methods： According to the retrospective analysis of all the 127 patients who were diagnosed as cystic lesions of the pancreas by the following methods such as ultrasonography, CT, MRCP, PET, ERCP,EUS and FNA. Results： 48 case of cystic lesions of the panCreas （38%） were selected an initial operation, and 79 of them （62%） selected follow-up visit. Nearly 40% of the patients who chose an initial operation were confirmed to suffer a malignant tumor by pathology. 9 patients（11%） of all the patients in the follow-up accept an operation because of their cystic lesions had a variation. According to the result of the pathology after the resection, 3 patients of them had a canceration. The patients in the follow-up whose lesion diameter was Smaller than 3cm, not existing a solid lesions, and without signs or symptoms, didn＇t have a risk in the transition to the malignant mutation. The transition rate was less than 4%, which was similar to the death risk of the patients undergoing resection.Conclusion：it is significant to adopt a careful radioactive follow-up to the surrounding parenchyma of all the patients who not an initial resection.