胰腺囊性病变161例外科诊治分析

Surgical diagnosis and treatment for pancreatic cystic lesions:161 resected cases summary

目的探讨胰腺囊性肿瘤的诊治策略。方法回顾性总结2002-2012年间复旦大学附属华山医院诊治胰腺囊性疾病的临床资料和手术治疗随访结果。结合病理分类的进展讨论胰腺囊性病变的外科诊治决策和趋势。结果共161例胰腺囊性病变病人接受手术治疗并有完整记录。术后病理诊断:胰腺假性囊肿24例(14.9%)、先天性囊肿19例(11.8%)、浆液性囊腺瘤/癌30例(18.6%)、黏液性囊腺瘤/癌18例(11.2%)、导管内乳头状黏液瘤/癌31例(19.3%)和实性假乳头状瘤/癌39例(24.2%)。无围手术期死亡病例,术后胰瘘发生率为46.0%(A级19.2%、B级25.5%、C级1.2%)。结论部分胰腺囊性病变有恶性肿瘤倾向,专业化诊治非常重要。腹部B超和CT、MRI检查具有特征性表现,是有效的诊断方法。首选手术切除是安全有效的治疗手段,尤其是术前疑为胰腺黏液性囊腺瘤、导管内乳头状黏液样瘤和实性假乳头状瘤者。

Objective To explore strategies of the diagnosis and treatment for pancreatic cystic lesions by retrospectively analyzing the clinical and pathological data over the last decade in a single-center institution. Methods Clinical data regarding diagnosis and treatment of cystic diseases of the pancreas, their surgical treatment and follow-up, from years 2002 to 2012 in Huashan Hospital, Fudan University was retrospectively analyzed. Decisions and trends of surgical treatment for the pancreatic cystic diseases by incorporating with their clincopathological classifications were discussed. Results A total of 161 cases of pancreatic cystic lesion underwent surgery, including about half the cases in Pancreatic Surgical Department in the past three years. Postsurgical pathology revealed pancreatic pseudocyst （14.9%）, congenital cysts （11.8%）, serous cystic neoplasm （18.6%）, mucinous cystic neoplasm （11.2%）, intraductal papillary mucinous neoplasm （19.3%） and solid pseudopapillary neoplasm （24.2%）. Overall postoperative pancreatic fistula rate was 45.96% with Grade A 19.2%, Grade B 25.5% and Grade C 1.2%. There was no perioperative deaths. Conclusion The diagnosis of pancreatic cystic lesions has increased significantly in past ten years, specialized diagnosis and treatment of pancreatic cystic lesions should be taken seriously because of their potential malignancy. Abdominal ultras0nography and abdominal CT/MR are effective diagnostic tools. Surgical resection is not only the preferred but also safe and effective treatment, especially with the preoperatively suspected pancreatic mucinous cystic neoplasm, intraductal papillary mutinous neoplasm and solid pseudopapillary neoplasm.