胰腺囊性肿瘤的诊断及治疗(附132例临床分析)

Diagnosis and treatment of pancreatic cystic neoplasms:clinical analysis of 132 cases

目的总结胰腺囊性肿瘤的诊断与外科治疗经验。方法回顾性分析北京协和医院2009年1月至2013年2月收治的】32例胰腺囊性肿瘤病人的临床资料。结果132例病人中行保留脾脏胰体尾切除术79例，胰体尾及脾切除术10例，保留十二指肠的胰头切除术3例，胰十二指肠切除术15例，胰腺肿瘤局部摘除术12例，胰腺节段切除术7例，全胰切除术1例，剖腹探查活检术5例。术后胰瘘（B、C级）发生率3．0％（4／132），术后出D-（B、C级）发生率5.3％（7／132），无围手术期死亡病例。随访恶性组22例病人，随访时间9～45个月，2例死亡，其余病人未发现肿瘤转移、复发。单因素分析发现，高龄（P=0．029），出现消瘦（P：0．019）、黄疸（P=0．021），影像学发现囊内结节或实性成分（P=0．015），肿瘤体积大（P=0．043）和血清肿瘤标记物（CA19—9，CEA）升高（P=0．006，P=0．009）与恶性病理密切相关；多因素分析发现，病人高龄（P=0．043）和血清CA19～9升高（P=0．048）是胰腺囊性肿瘤恶性的独立危险因素。结论胰腺囊性肿瘤病人无特征性临床表现，影像学检查对其诊断意义重大。有临床症状或有恶性征象者应积极行手术治疗。可根据肿瘤位置、大小、与胰管关系、性质等决定手术方式，尽量保留器官功能。

Objective To summarize the experience in diagnosis and treatment of pancreatic cystic neoplasms. Methods The clinical data of 132 patients diagnosed with pancreatic cystic neoplasms treated in Peking Union Medical College Hospital from Jan 2009 to Feb 2013 were retrospectively analysis. Results Spleen-preserving distal pancreatectomy, distal pancreatectomy, Beger procedure, Whipple procedure, tumor enucleation, segment resection, total pancreatectomy and biopsy were performed in 79, 10, 3, 15, 12, 7, 1, 5 Patients, respectively. No patient died within the perioperative period. Pancreatic fistula （B and C） occurred in 4 patients （3%）, postoperative hemorrhage（B and C） occurred in 7patients （5.3%）.All 22 patients in malignant group were followed up from 9 to 45 months. 2 patients died and the others survived without relapse and metastasis .The following factors including old age （P=0.029）, with clinical symptoms （P=0.024）, weight loss （P=0.019）, jaundice （P--0.021）, having solid component or nodule （P=0.015）, big size （P=0.043）, elevated serum CA19-9 and CEA （P=0.006, P=0.009）were significantly correlated with malignant cystic neoplasms of pancreas in univariate analysis, old age （P=0.043）and elevated serum CA19-9 （P=0.048）were identified as independent predictive factors for malignancy by multivariate analysis. Conclusion There is no specific symptom of pancreatic cystic neoplasms. Morphological study plays an important role in the diagnosis. Patients with clinical symptoms or highly suspected malignant lesion should be operated in accordance with tumor location, size, and relationship between pancreatic duct, as well as pathological features. The function of the pancreas should be preserved.