恶性与交界性胰腺囊性疾病的临床因素分析

Analysis on clinical predictive factors of malignant and premalignant cystic lesions of the pancreas

目的探讨良恶性胰腺囊性疾病(cystic lesions of the pancreas,CLP)的临床因素。方法回顾性分析手术后经病理证实的49例CLP的临床特征。结果胰腺管状腺癌囊性变5例;肉瘤样癌囊性变1例;黏液性囊性肿瘤8例(恶性2例,交界性5例,良性1例);胰腺实性假乳头状肿瘤14例(恶性1例,交界性13例);囊性胰腺内分泌肿瘤2例(良恶性各1例);浆液性囊腺瘤10例(均为良性);无恶性潜能的CLP 9例(海绵状血管瘤2例,慢性胰腺炎伴潴留性囊肿3例,胰腺黏液性非肿瘤性囊肿1例,胰腺假性囊肿1例,潴留性囊肿1例,良性上皮性囊肿1例)。恶性肿瘤组患者的年龄为(64.70±11.23)岁,明显高于交界性肿瘤组[(34.33±15.83)岁]和良性病变组[(47.29±14.068)岁]。恶性肿瘤组肿瘤最大直径(8.09±3.98)cm,明显大于良性病变组[(5.25±3.22)cm]。恶性肿瘤组CA19-9的阳性率为60.0%,明显高于交界性肿瘤组(0)和良性病变组(11.8%)。恶性肿瘤组CEA的阳性率为40.0%,其余两组均正常。CT诊断CLP的符合率为87.9%,肿瘤的边界是否清楚、有无实性成分有助于区别良恶性。结论对于男性、年龄大,血清肿瘤学标志物升高明显、影像学表现为边界不清或有实性成分的CLP患者应采取积极治疗。

Objective To identify preoperative predictive factors associated with malignancy of cystic lesions of the pancreas （CLP）. Methods A retrospective review of 49 pathologically confirmed cases of CLP was performed. Results Pathologic analysis revealed 5 ductal adenocarcinomas with cystic features, 1 sarcoma cystic degeneration,8 mucinous cystic neoplasms（ malignant lesions 2 patients, borderline lesions 5 patients, benign lesion 1 patient）, 14 solid pseudopapillary neoplasms（ malignant lesion 1 patients, borderline lesions 13 patients） ,2 cystic pancreatic endocrine neoplasms（ malignant lesion 1 patient, benign lesion 1 patient）, 10 serous cystic neoplasms （ all benign） ,2 pancreatic cavernous hemangiomas ,3 chronic pancreatitis with retention cysts, 1 mutinous non-neoplastic cyst, 1 pancreatic pseudocyst, 1 retention cysts and 1 be- nign epithelial cyst. The malignant group was significantly older than that of the borderline and benign groups. The diameter of the malignant group were larger than that of benign group （ P = 0. 035 ）. The positive rates of CA19-9 in malignant group was 60. 0% , were much higher than that of borderline（0% ） and benign groups（ 11. 8% ）. The positive rates of CEA in malignant cystic lesions were 40. 0% , and the borderline and benign groups were normal. The coincidence rate of CT in the diagnosis of CLP is 87.9%. The clearity of boundary and presence of solid component were predictors of CLP with or without malignancy. Conclusions Male gender, increasing age, elevated tumor marker, the presence of solid component, indefined margins, were all indications for increased malignancy and consideration for operative treatment.