小儿胰腺实性假乳头状瘤的诊断与外科治疗

Diagnosis and surgical therapy of pancreatic solid pseudopapillary tumor in children

目的总结小儿胰腺实性假乳头状瘤（solid pseudo-papillary tumors of pancreas，SPTP）的诊断及治疗经验。方法回顾性分析2002年1月至2011年12月9例胰腺实性假乳头状瘤患儿的临床资料。其中，男1例，女8例；中位年龄11岁5个月。结果4,JLSPTP无特异性临床表现，主要临床表现为腹痛或腹部不适，CT检查均提示胰腺囊实性或实性占位。手术证实肿瘤位于胰头、颈部4例，胰体部2例，胰尾部3例。肿瘤直径2．8～16．4cm，无腹腔或肝脏转移。行胰十二指肠切除术（Child术）2例，肿瘤局部切除术4例，胰腺节段切除、胰肠吻合术1例、胰尾联合脾脏切除术1例，保留脾脏的胰体尾切除1例。9例肿瘤标本在显微镜下均具有sFTP的典型病理学表现。随访3个月-8年，均未发现肿瘤复发及转移。结论CT是小儿SPTP重要的诊断方法，手术为其主要治疗方式，手术术式的选择应依据术前CT和术中对肿瘤部位、包膜是否完整和是否侵及周围组织的探查来决定。

Objective To summarize the diagnostic and therapeutic experiences of solid pseudopapillary tumor of pancreas （SPTP） in children. Methods Clinical information of 9 cases of pediatric SPTP （F 8; M 1; Mean age： 11 years and 5 months） was studied retrospectively and these patients underwent treatment from January 2002 to December 2011 in our center. Results There were no specific clinical manifestations in children with SPTP; such patients mainly presented abdominal pain or discomfort. CT scanning suggested cystic-solid or solid masses occupation could be seen in pancreas. During the operation, the tumors tissue was found to locate in the pancreatic head or neck in 4 cases, 2 cases of tumor were in pancreatic body and 3 cases of tumors were in pancreatic tail. The tumor diameter ranged from 2. 8 em to 16. 4 cm, and no abdominal or liver metastasis was noted. Panereaticoduodenectomy （Child procedure） were performed in 2 patients, local resection of tumor tissue were performed in 4 patients, segmental pancreatectomy and pancreaticojejunostomy was performed in 1 patient respectively, 1 patient underwent distal pancreatectomy combined splenectomy, and 1 patient underwent distal panereateetomy. The histological examination revealed SPTP. Follow-up period ranged from 3 mouths to 8 years, and no recurrence and metastasis were found in all. Conclusions CT scanning is the important method to diagnosis in children with SPTP, surgery is the main and effective therapeutic strategy. The procedures should be chosen based on the findings of preoperative CT imaging and intraoperative exploration of tumor location, and capsular integrity of the tumor, as well as infringement of surrounding tissue.