胰腺大囊性浆液性囊腺瘤临床分析

Macrocystic serous adenoma of the pancreas： a report of 5 cases

目的 探讨胰腺大囊性浆液性囊腺瘤（MSAP）的诊断与治疗.方法 对1999年10月至2009年10月收治的5例MSAP患者的临床资料进行回顾性分析.男性1例,女性4例.结果 5例MSAP患者中,临床表现为腹痛、腹胀3例,黄疸1例,无明显症状1例.超声和CT检查显示胰腺大囊性占位性病变;其中5例均边界清楚、有分隔、囊壁强化、未见囊壁结节及乳头状突起;4例囊壁光滑、较薄;3例病灶为分叶状,2例病灶为类圆形;2例伴胰管扩张,1例伴胆道扩张.5例MSAP中,肿瘤发生于胰头2例、胰体尾3例,肿瘤直径均大于5.0 cm,平均直径8.8 cm.5例均行手术切除,术后2例发生胰瘘,均治愈.随访8～35个月,未见复发.结论 MSAP缺乏特异性临床表现,超声和CT等影像学特征与胰腺黏液性囊性肿瘤相似,肿瘤逐渐增长并产生压迫症状,手术切除后可治愈.

Objective To investigate the diagnosis and treatment of macrocystic serous adenoma of the pancreas （MSAP）. Methods The clinical data of 5 patients with MSAP treated from October 1999 to October 2009 were retrospectively analyzed. There were 5 female and 1 male. Results Of the 5 patients,3 patients presented with abdominal pain and fullness, 1 patient with jaundice, 1 patient with asymptomatic. Ultrasounography and CT could manifest macrocystic lesion of the pancreas; all the lesion showed a well-defined border, internal septations, enhanced cyst walls, with no intramural （ mural ） nodule and papillary projections; the wall was smooth and thin in 4 cases; irregular lobulation could be obseverd in 3 cases, round or oval in 2 cases; 2 cases had pancreatic duct dilatation, 1 case had biliary duct dilatation. The tumors located in the pancreatic body and tail in 3cases, the tumors located the pancreatic head in 2 cases. The sizes of the tumors ranged from 6.5 cm to 13.0 cmm（ mean,8.8 cm）. Five patients all accepted surgical intervention. The main postoperative complication was pancreatic fistula （2 cases） ;all the fistula was cured. Recurrence or metastasis were not found in 5 patient followed up postoperatively from 8 to 35 months. Conclusions MSAP has no specific sysptoms. The imaging appearance of MSAP is similar to mucinous cystic neoplasm of the pancreas. The tumor can gradually grow up and produce compression symptoms. MSAP can be cured by complete resection.