胰腺非导管腺癌性占位114例临床病理学分析

Clinical and pathological analysis of 114 cases with non-ductal pancreatic adenocarcinoma occupying lesions

目的提高胰腺非导管腺癌性占位的诊疗水平。方法收集中国医学科学院肿瘤医院1999年1月至2007年12月间经病理确诊的胰腺非导管腺癌性占位114例，对其临床特点和治疗进行回顾性总结。结果临床资料：（1）男36例，女78例；（2）腹痛56例，腰背疼痛24例，消瘦18例，黄疸8例；（3）糖抗原19-9（CA19-9），糖抗原242（CA242）和癌胚抗原（CEA）的阳性率分别为21．1％、19．7％、5．6％；（4）Whipple术26例，胰体尾切除术53例，肿瘤摘除术15例，胰腺中段切除术9例，肿瘤部分切除术3例，保留十二指肠的胰头切除术1例，姑息性手术（包括胆肠旁路和胃空肠吻合）7例。（5）胰腺实性假乳头状瘤35例（30．7％），胰腺内分泌肿瘤28例（24．6％），肿块型慢性胰腺炎18例（15．8％），胰腺浆液性囊腺瘤11例（9．6％），胰腺黏液性囊性肿瘤9例（7．9％），胰腺囊肿4例（3．5％），胰腺腺泡细胞癌3例，胰腺海绵状血管瘤2例（2．6％），其他肿瘤6例（5．3％）包括胰腺未分化肉瘤1例，胰腺肉瘤样癌1例，胰腺神经鞘瘤1例，胰腺神经母细胞瘤1例。结论胰腺非导管腺癌性占位无特异性的临床表现，实验室检查也无特异性的肿瘤标志物。了解各种疾病的自然病程，有助于决定治疗方案。

Objective To improve the diagnosis and treatment of non-ductal pancreatic adenocarcinoma-occupying lesions. Methods A retrospective analysis was made for 114 cases of pancreatic non-ductal adenocarcinoma-occupying pathologically confirmed lesions. Results （1）There were 36 males （31.6%） and 78 females （68.42%） ; （2）presenting symptoms and signs were abdominal pain （ n = 56, 49. 1% ）, back pain （n =24, 21.1% ）, weight loss （n = 18, 15.8% ） and obstructive jaundice （n =8, 0. 07% ） ; （3）the positive rates of CA19-9, CA242 and CEA were 21.1% , 19. 7% and 5.6% respectively; （4）pancreaticoduodenectomy was performed in 26 patients, distal pancreatectomy in 53, tumor enucleation in 15, segmental pancreatectomy in 9, partial resection in 3, duodenum-preserving pancreatic head resection in 1 and palliative surgery （either eholecystojejunostomy anastomosis or gastrojejunostomy）in 7; （5）pathologic analysis revealed 35 solid pseudopapillary neoplasm of pancreas, 28 pancreatic endocrine tumors, 18 focal chronic pancreatitis, 11 serous cystic neoplasms, 9 mutinous cystic neoplasms, 4 pancreatic cysts, 3 acinar cell carcinomas, 2 pancreatic cavernous hemangiomas, 1 sarcoma of pancreas, 1 sarcomatiod carcinoma of pancreas, 1 pancreatic schwannnoma and 1 pancreatic neuroblastoma. Conclusion The non-ductal pancreatic adenocarcinoma-occupying lesions have no specific clinical presentation or serum tumor marker. An understanding of the natural history of these lesions is important for optimal management.