胰腺浆液性囊腺瘤57例临床分析及治疗探讨

Clinical characteristics and treatment of 57 patients with serous cystadenoma of pancreas

目的探讨胰腺浆液性囊腺肿瘤的临床诊断及治疗。方法回顾性分析57例术后病理确诊为胰腺浆液性囊腺瘤患者的临床资料。结果57例患者中，男13例（22．8％），女44例（77．2％），平均年龄56．8岁。术前无临床症状者31．6％，CT的正确诊断率为70．6％。57例均为经手术治疗的患者，其中胰十二指肠切除术17例（29．8％），保留或不保留脾脏的胰腺远端切除术38例（66．7％），姑息术1例，肿瘤剥除术1例。术后出现并发症6例（10．5％）。术后病理为微囊型浆液性囊腺瘤50例（87．7％），寡囊型浆液性囊腺瘤7例（12．3％）。包括微囊型浆液性囊腺癌1例。随访12个月至15年，除1例浆液性囊腺癌患者于术后13个月死亡外，均获得长期生存。按术后病理分型及肿瘤大小分组行统计分析，寡囊型患者的术后平均住院日大于微囊型[（17．39±7．61）d比（19．43±0．98）d，P=0．002]，肿瘤最大径≥4cm组患者临床症状发生率高于〈4cm组（76．1％比23．9％，P=0．03），其余临床指标差异无统计学意义。结论胰腺浆液性囊腺瘤是一种少见的胰腺囊性肿瘤，多发于中老年女性。笔者认为，有症状的、肿瘤直径大于4cm的、有恶性生物学行为倾向或无法排除其他潜在恶性肿瘤的患者是手术切除的适应证。无症状且肿瘤小于4cm者如随诊发现肿瘤进行性增长证据也应手术切除。

Objective To analyse the diagnosis and treatment options of serous cystadenoma of the pancreas. Method The clinical data of 57 patients operated in the Tianjin Medical University Cancer Institute ＆ Hospital from August 1996 to December 2011 with pathologically confirmed serous cystadenoma of pancreas after the operation were retrospectively studied. Results There were 13 males （22.8%） and 44 females （77.2%）. The median age was 56.8 years. The patients were asymp tomatic in 31.6%. CT was accurate in the diagnosis in 70.6%. All patients received surgical resec tion, inluding pancreaticoduodenectomy （n=17, 29.8%）, distal pancreatectomy （n=38, 66.7%）, palliative resection （n= 1）, and tumor enucleation （n= 1）. Postoperative complications developed in 6 patients. Histopathologically, there were 50 cases of serous microcystic adenoma （87.7%） and 7 cases of serous oligocystic adenoma （12.3 %）. One of these patients had developed into serous cystadenocarcinoma. At a follow-up of 12 months to 15 years, one patient with serous cystadenocarcinoma died 13 months after the operation. The remaining patients were all alive. Statistical analysis was performed based on the postoperative histopathological type and tumor size. The mean postoperative hospital stay of the group of patients with serous microcystic adenoma were significantly longer than the patients with serous oligocystic adenoma [-（17.39±7.61） d vs （19.43±0.98） d, P=0. 002]. The incidence of patients with clinical symptoms was higher in the group of patients with tumor size ≥4 cm when compared with the patients with tumour size 〈4 cm. There was no significant difference on the other parameters. Conclusions Pancreatic serous cystadenoma is a rare pancreatic tumor, and it often happens in elderly women. Indications for surgical resection included symptomatic tumours, tumor diameter more than 4 cm, malignant biological behavior, malignancy could not be ruled out, and poten-tially malignant tumors. For asymptomatic patients and tumor size less than 4 cm, surgical resection should also be considered if the tumour progresses on follow-up.