胰头部胰腺实性假乳头状瘤的手术治疗

Surgical treatment of the solid pseudopapillary tumor located at the head of pancreas

目的评价胰头部胰腺实性假乳头状瘤（SPTs）的手术方法及其疗效。方法总结1999年1月-2009年6月收治的24例胰头部SPTs病例，手术分为肿瘤剜除组（12例）及行胰十二指肠切除或保留幽门胰十二指肠切除术（PD／HPPD）组（12例），回顾性对比分析研究两组的一般资料、手术治疗、术后并发症及预后情况。结果两组的年龄及肿瘤大小无差异；剜除组手术时间及术中出血量明显少于PD组（P〈0．05，P〈0．01）；剜除组术后并发症略多于PD组，但二者之间无显著性差异。PD／HPPD组明显恶性1例，局部浸润性生长1例。除1例恶性者术后1年复发外，其余患者目前无肿瘤复发。结论对包膜完整、无明显恶性表现的胰头部SPTs，宜尽量行肿瘤剜除手术治疗。对怀疑恶变的胰头部SPTs，应行标准的胰十二指肠切除术或扩大的胰十二指肠切除术。

Objective To summarize the surgical therapies and prognoses of 24 solid pseudopapillary tumors （SPTs） located at the head of pancreas in the past ten years. Methods The clinical features, surgi- cal treatment, postoperative complications and prognosis of the enucleation group and the PD/HPPD group were compared retrospectively. Results There were 12 patients in each group. There was no significant difference in the ages of the patients and the SPTs size between the two groups. The operation time and the intraoperative hemorrhage of the enucleation group were all less than the PD/HPPD group （ P 〈 0. 05, P 〈 0. 01 ）. The postoperative complications of the enneleation group were more than the PD/HPPD group, but there were no statistical differences between the two groups. One case of SPT was malignant in the PD group and one StrF was locally infiltrated. The malignant case was found recurrent on year after operation, and all the other cases were not found recurrent. Conclusions It is helpful to perform enucleation for the young pa- tients with integrated membrane and no malignant tendency SPTs located at the head of pancreas. But for ma- lignant SPTs located at the head of pancreas, pancreaticoduodenectomy or enlarged pancreaticoduodenectomy should be performed on PD/HPPD.