胰腺实性假乳头状瘤26例诊治分析

Analysis of diagnosis and treatment of 26 cases with solid pseudopapillary tumors of the pancreas

目的探讨胰腺实性假乳头状瘤（solid pseudo—papillary tumor of the pancreas，SPT）的最佳术式选择。方法回顾性分析1998年至2008年期间武汉协和医院胰腺外科中心收治26例SPT患者的临床资料。结果10例患者经B超检查发现胰腺混合回声实性或周边低回声而中央无回声的囊实性病变，13例CT证实胰腺囊实性肿块伴囊内钙化，3例MRI提示肿块呈高低混杂信号且增强后实性部分明显强化，仅5例患者在术前经B超或CT引导下经腹细针穿刺活检而确诊。所有患者均行手术治疗，9例肿瘤局部切除，7例保留十二指肠胰头切除，9例胰体尾和或脾脏切除，1例行胰头十二指肠切除。术后均恢复较好，3例发生术后胰瘘。对所有患者长期随访，仅有1例患者因肿瘤复发再次行手术切除。结论SPT是一种少见的低度恶性肿瘤，手术切除是其治愈的唯一手段且预后好。B超、CT和MRI等影像学表现具有相对特征性，对其早期诊断极为重要。B超或CT引导下经腹细针穿刺活检对术前确诊和术式选择有重要意义。

Objective To approach clinical feature and best surgical treatment of solid pseudo - papillary tumors （SPT） of the pancreas. Methods From 1998 to 2008,26 patients with SPT of the pancreas in our center were reviewed retrospectively. Results Of 26 cases, 10 were found having mixed echo ,or hypoecho in surrounding and central anecho of pancreatic cystic lesions by B ultrasound, 13 cases had solid cystic masses and intracystic calcification on CT, and 3 had mixed signal intensities of the pancreas on MRI and after contrast the solid part was enhanced. Only 5 cases were pre - operatively diagnosed by B ultrasound or CT - guided fine needle aspiration and biopsy. All 26 cases received surgical operation successfully,9 cases single tumorectomy ,7 patients duodenum -preserving pancreatic head resection,9 patients distal pancreatectomy with or without splenectomy,and one case pancreato duodenectomy. All patients recovered well, and 3 cases had postoperative pancreatic fistula. All patients were followed up, and only one received re - operation due to tumor recurrence. Conclusion SPT is a rare neoplasm with low malignant potential and has a good prognosis. Surgical operation is unique way to cure completely. Imaging techniques including B ultrasound, CT and MRI have comparative characteristics and are extremely important for the early diagnosis of SPT. And B ultrasound or CT - guided fine needle aspiration and biopsy has important significance to preoperative diagnosis and surgical treatment.