胰腺囊性肿瘤的手术治疗时机和方式探讨

Surgical Approach of Pancreatic Cystic Tumor

【目的】初步探讨胰腺囊性肿瘤的手术治疗时机、方式以及术后并发症的处理。【方法】回顾性分析我院自1998年1月至2009年12月收治的31例胰腺囊性肿瘤患者的临床、病理以及术后随访资料;其中胰腺浆液性囊腺瘤16例,黏液性囊腺瘤8例(其中1例为黏液性囊腺癌),导管内乳头状黏液性肿瘤4例,实性假乳头状瘤3例;肿瘤位于胰头颈部者12例,位于胰体尾部者19例。【结果】所有患者均经手术治疗,其中10例行胰十二指肠切除术、1例行保留十二指肠的胰头切除术、10例行胰体尾切除术、2例行腹腔镜下胰体尾肿瘤切除术、3例行胰腺肿瘤局部剜除术、4例行胰腺节段切除术;1例黏液性囊腺癌患者仅可行姑息手术。本组病例无围手术期死亡,2例患者术后发生胃瘫,4例患者术后发生胰瘘,均可经保守治疗痊愈。除1例囊腺癌患者外,其余30例患者随访6～96个月,均未出现胰腺肿瘤复发或转移。【结论】胰腺囊性肿瘤的具体病理类型术前很难准确判断,对于难以定性的囊性肿瘤及时手术是防止肿瘤癌变的重要手段;手术方式选择应该个体化,并应遵循损伤控制性原则,有条件的单位应该多开展经腹腔镜微创手术。

【Objective】 To explore the surgical approach of pancreatic cystic tumor.【Methods】 From January 1998 to December 2009,31 patients with pancreatic cystic tumor were underwent operations in our hospital,including serous cystic neoplasms（16 cases）,mucinous cystic neoplasms（8 cases,including 1 mucinous cystic carcinoma）,intraductal papillary mucinous neoplasms（4 cases）,and solid pesudopapillary neoplasms（3 cases）.And the clinical data of 31 cases were analyzed retrospectively.【Results】 Pancreato-duodenectomy were performed in 10 cases,and duodenum-preserving pancreatic head resection was performed in 1 case.Distal pancrectomy were performed in 10 cases,and laparoscopic distal pancrectomy were performed in 2 cases.Middle segment resection were performed in 4 cases,and tumor enucleation were performed in 3 cases.But 1 patient with mucinous cystic carcinoma underwent palliative operation and only survived 4 months after surgery.There was no perioperative death,while postoperative gastroparesis was occurred in 2 cases,and pancreatic fistula was occurred in 4 cases.Thirty patients with benign diseases were followed up 6～96 months,and there were no tumor recurrence or metastasis.【Conclusion】 It is difficult to confirm the definite pathological category of pancreatic cystic tumor before operation.Positive and timely surgery should be performed as a cancer preventive treatment.The selection of surgical approach should be individualized,followed by damage control principle.Laparoscopic operation can be recommended to popularize in high volume center.