胰腺实性假乳头状瘤8例的临床诊治

Diagnosis and therapy of pancreatic solid pseudo-papillary tumor in 8 cases

目的 总结胰腺实性假乳头状瘤（SPTP）的临床特点及其诊断、治疗、预后.方法 回顾性分析中南大学湘雅医院2011年7月～2013年4月8例SPTP患者的临床资料.结果 8例SPTP没有特异性临床表现,主要表现为腹痛、腹部包块,影像学检查都提示胰腺实性或囊实性占位,其中实性2例（占25％）,囊实性6例（占75％）.术中所见位于胰头部6例（占75％）、胰体尾部2例（占25％）.肿瘤直径2.5～13.5 cm,无淋巴结及肝脏转移.8例患者均行手术切除,其中行肿瘤切除术2例,行胰十二指肠切除术3例,行局部肿瘤切除术2例,行保留脾脏的胰体尾切除术1例,无手术死亡.术后病检回报均符合SPTP的典型病理学表现,3例术后出现胰瘘,均经保守治疗治愈.术后随访2月～2年,均未发现肿瘤转移或复发.结论 SPTP是一种少见的低度恶性肿瘤,诊断主要依靠CT,临床治疗主要依靠外科手术,根据术前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手术术式.预后相对良好,胰痿是术后的主要并发症.

[Objective] To summarize the clinical feature, diagnosis, differentiated therapeutics and prognosis of solid pseudo-papillary tmnor of pancreas （SFFP）. [Methods] Clinical information of 8 cases of SPTP was studied retrospectively and these patients underwent treatment from July 2011 to April 2013 in our hospital. [Results] There were no specific clinical manifestations in the 8 patients with SPTP, such patients mainly presented abdominal mass or pain. hnaglng examination suggests solid mass in 2 cases （25%） or cystic-solid in 6 cases （75%） masses oc- cupation could be seen in pancreas. During the operation, the tumors tissue was found to locate in the panereatic head in 6 eases（75%）, and 2 eases（25%） of tumor were in pancreatic body or tail. The diameter of the tumor ranged from 2.5 em to 13.5 cm, and no lymphatic or liver metastasis was noted. All patients were treated surgically, there into tumor tissue were performed in 2 patients, and pancreati eoduodenectomy（Child procedure） were performed in 3 patients, local resection of tumor tissue were performed in 2 patients, and 1 patient underwent distal panereatecto- my, no patient died during the operation. The histological examination revealed SPTP, 3 postoperative pancreatic fis- tulae cases were all recovered from symptomatic treatment. Follow-up period ranged from 2 mouths to 2 years, and no reemTenee or metastasis was found in total. [ Conclusions ] SPTP is a rare borderline tumor or neoplasm with a low metastatic potential, and CT scanning is an important method, and surgery is the main and effeetive therapeutic strategy. The procedures should be chosen based on the findings of preoperative CT imaging and intra-operative ex- ploration of tumor location, and capsular integrity of the tumor, as well as infringement of surrounding tissue. The prognosis is excellent, and pancreatic fistula is the main postoperative complication.