胰腺实性假乳头状瘤16例诊治分析

Clinical analysis of solid-pseudopapillary tumor of the pancreas in 16 cases

目的总结胰腺实性假乳头状瘤的诊治经验。方法对2005年1月．2009年12月收治的16例胰腺实性假乳头状瘤病例的临床表现、影像学特征、病理结果、治疗和预后进行回顾性分析。结果肿瘤位于胰腺头部及钩突部者5例，位于颈体部者5例，位于尾部者6例。首发症状表现为间断性上腹部隐痛不适者7例，体重下降者2例，查体时发现腹部肿块者3例，体检发现胰腺肿瘤者4例。B超表现为回声不均的囊实性病变或低回声实性病变；SCT表现为胰腺实性或囊实性占位病变，低密度、不均匀、边界清楚、形态规则，增强扫描时呈高血供表现。肿瘤标记物无异常。行胰体尾切除加脾切除术者9例，其中1例因侵犯横结肠加行左半结肠切除术。4例行肿瘤局部切除术。3例患者行保留十二指肠及部分胰头、肿瘤切除，胰体空肠Roux—ell—Y吻合术。随访时间3～48个月，未发现肿瘤复发或转移。结论胰腺实性假乳头状瘤好发于年轻女性，可位于胰腺的任何部位，临床表现无特异性，手术切除是治疗的有效途径，预后良好。

Objective To summarize the experience in diagnosis and treatment for solid-pseudopapillary tumors of the pancreas （SPT）. Methods A retrospective clinical analysis about clinical, imaging and pathologic data was made on 16 cases of SPT admitted from January 2005 to December 2009. Results Five had SPT in the head of the pancreas, 5 in the body of the pancreas, 6 in the tail of the pancreas. The first symptom was intermittent epigastrie pain （ n = 7）, abdominal aponia mass （ n = 3 ）, Pancreatic tumor found by chance （ n = 4）, weight loss （ n = 2）. Solid and Solid- cystic masses of low echo were found in US. Mas- ses of low density in pancreas were found on CT scan, while irregular enhancement appeared in the circum- ference of all tumors in enhanced CT scan sequences. Tumor markers in patients＇ erum were all negative. 9 patients underwent distal pancreatectomy and spleen resection, including 1 patient also underwent left hemicolectomy. Local excision of tumor was performed in 4 cases. Pancreatic local excision and pancreatico- jejunostomy were performed in 3 cases. 14 cases were followed up with an period of from 3 to 48 months. No evidence of relapses and metastasis in these cases was found. Conclusion SPT primarily affects young women, and it may be located in any part of pancreas. Surgical resection is recommended as the treatment of choice. The prognosis is good.