胰腺囊性肿瘤212例诊治分析

Diagnosis and treatment of cystic neoplasms of pancreas:retrospective analysis of 212 cases

目的探讨胰腺囊性肿瘤诊断和治疗的原则及方法。方法回顾性分析2001年1月至2010年12月复旦大学附属中山医院手术切除的212例胰腺囊性肿瘤病例的临床资料。结果 212例胰腺囊性肿瘤中,导管内乳头状黏液性肿瘤(IPMN)101例(48%),黏液性囊性肿瘤(MCN)49例(23%),浆液性囊性肿瘤(SCN)62例(29%)。病人无特征性临床表现;超声、CT和MRI对胰腺囊性肿瘤的诊断正确率分别达到90%,93%和94%;胰腺囊性肿瘤术后胰瘘发生率为34.3%;SCN和非侵袭性IPMN和MCN的5年存活率为100%,侵袭性IPMN和MCN的5年存活率分别为35%和31%。结论 CT及MRI是胰腺囊性肿瘤术前诊断的主要手段;SCN和非侵袭性IPMN和MCN预后好,功能保留性胰腺手术有应用价值,侵袭性IPMN和MCN应规则胰腺切除加区域淋巴结清扫;胰腺囊性肿瘤总体预后较好。

Objective To investigate the diagnosis and treatment of cystic neoplasms of the pancreas. Methods Retrospective analysis was made on the clinical data of 212 cases of pancreatic cystic neoplasms from January 2000 to December 2010 in Zhongshan Hospital. Results There were 101 cases of IPMNs（48%）, 49 cases of MCNs（23%） and 62 cases of SCNs（29%）. No special clinical manifestation was observed. 90%, 93% and 94% accuracy can be achieved by ultrasound, CT and MRI on the diagnosis of cystic tumor respectively. The postoperative incidence of pancreatic fistula is 34.3%. All the cases of SCN, non-invasive MCN and IPMN survived five years or longer, while the five-year survival rate of invasive MCNs and IPMNs is just 31% and 35% respectively. Conclusion Both CT and MRI are accurate on preoperative diagnosis of pancreatic cystic tumors. Priority should be given to function-saving-operation for SCN, non-invasive MCN and IPMN cases, while the invasive PNCs should receive standard pancreatectomy plus regional lymph nodes dissection. The overall prognosis of pancreatic cystic tumor is satisfactory.