胰腺囊性肿瘤35例诊治分析

Diagnosis and treatment of 35 cases of pancreatic cystic neoplasms

目的探讨胰腺囊性肿瘤的诊断和治疗。方法对35例胰腺囊性肿瘤病例资料进行回顾性分析。结果术前诊断率：B超为28．6％（10／35），CT为44．4％（12／27），MRI为70％（7／10）。28例行手术治疗，并为术后病理确诊，其中浆液性囊腺瘤2例，黏液性囊腺瘤9例，囊腺癌7例，胰腺导管内乳头状黏液性肿瘤3例，胰腺实性假乳头状瘤7例。获得随访23例：胰腺囊腺瘤术后5年存活率为62．5％（5／8），无复发病例；胰腺囊腺癌完整切除者最长存活5年8个月，未能完整切除者最长存活6个月；胰腺实性假乳头状瘤4例，均健在，最长已存活4年。结论胰腺囊性肿瘤术前诊断较困难，CT及MRI对本病的诊断帮助较大。外科切除是最有效的治疗手段。加强各科医师之间的交流与合作、及早发现、恰当的手术方法，有助于提高本病的诊治效果。

Objective To investigate the diagnosis and treatment of pancreatic cystic tumors. Methods The clinical data of 35 patients with pancreatic cystic tumors were retrospectively analyzed. Results The preoperative diagnosis rate was as follows： ultrasound was 28.6% （ 10/35 ）, CT 44.4% （ 12/27 ）, MRI 70% （7/10）. Twenty-eight cases underwent operation and were diagnosed finally by postoperative patholo- gy. Serous cystic neoplasm （SCN） was found in 2 cases, mucinous cystic neoplasm （MCN） in 9 cases, cystic adenocarcinoma in 7 cases, intraductal papillary mucinous neoplasm （IPMN） in 3 cases, solid pseud- opapillary tumor （SPT） in 7 cases. Twenty-three cases were followed up successfully. The post-operative 5 years survival rate was 62.5% （5/8） in pancreatic cystic adenoma without recurrence. The longest survival time in cystic adenocarcinoma after complete resection was 5 years and 8 months, while in which after incom- plete resection was 6 months. The 4 cases of SPT are all alive, and one of them has survived for 4 years as the longest one. Conclusions It is difficult to diagnose the pancreatic cystic neoplasm accurately before op- eration. CT and MRI may be helpful to make the diagnosis. Surgical resection is the most effective treat- ment. The enhancement of the communication and cooperation between the related departments, the early di- agnosis, and the appropriate operation are needed to improve the diagnostic and therapeutic efficacy.