胰腺实性-假乳头状瘤22例诊疗体会

Diagnosis and treatment of 22 cases of solid pseudopapillary tumor of the pancreas

目的:探讨胰腺实性-假乳头状瘤(solid pseudopapillary tumor of the pancreas,SPTP)的临床表现特点和治疗方法。方法:回顾性分析2004年1月—2010年11月山东省立医院收治的22例经手术治疗,且术后病理证实为SPTP的患者的临床资料。结果:患者包括21例女性及1例男性,平均年龄为23.4岁。首诊原因多为查体发现胰腺包块而无明显临床症状,另可伴有腹痛、腹胀。影像学检查均提示胰腺或腹腔内边界清楚的实性或囊实性占位病变,CT强化扫描示肿瘤实性部分呈轻、中度强化,囊性部分无明显改变。手术方式包括局部肿瘤切除术8例,胰腺节段切除术2例,胰体尾联合脾脏切除术6例,胰尾部肿瘤切除合并保留脾脏4例,保留十二指肠胰头切除1例,1例发生肝脏转移者行肿瘤局部切除联合肝脏转移瘤切除。术中发现肿瘤分界清楚。除1例发生肝转移外,余患者肿瘤未发现周围器官、血管明显浸润。术后随访无复发及转移。结论:SPTP是一种低度恶性肿瘤,手术是首选治疗方法,尽量首选肿瘤局部切除术,以减少手术创伤。

Objective： To further investigate the clinical features,diagnosis and surgical treatment strategy of solid pseudopapillary tumor of the pancreas（SPTP）.Methods： From Jan.2000 to Nov.2010,22 SPTP patients confirmed by pathology diagnosis were analyzed retrospectively,including the clinical and pathological features,radiological findings and surgical interventions.Results： The patients including 21 famales and 1 male usually presented with a asymptomatic pancreatic mass detected incidentally.The rest of the clinical manifestations included abdominal pain and distention.The imaging findings showed a well-demarcated mass which was composed of solid-cystic portion.On post-contrast CT the solid portions could be enhanced.All pancreatic tumor resections were successfully completed,which included local tumor excision（8/22）,distal pancreatectomy with splenectomy（6/22）,spleen-preserving distal pancreatectomy（4/22）,resection of the midportion of the pancreas and the mass with preserving the rim of the head and tail portion（2/22）,duodenum-preserving resection of pancreatic head（1/22）,enucleation of SPTP and liver metastasis（1/22）.No severe adhesion or invasion of the SPTP to the adjacent organs and vessels was noted on surgical exploration,except a patient which liver metastasis was found.No mortality and local recurrence or distant metastasis were found in the following-up period.Conclusion： SPTP is a low-grade malignant tumor,and once the diagnosis of SPTP is made,less aggressive surgical procedures are proposed.