胰腺黏液性囊性肿瘤的临床病理特点和CT影像学特征

Clinicopathological and CT features of mucinous cystic neoplasms of the pancreas

目的了解胰腺黏液性囊性肿瘤的临床病理特点和CT影像学特征，分析与恶性胰腺黏液性囊性肿瘤发生相关的危险因素。方法回顾性分析1994年4月至2013年1月间经手术病理证实的98例胰腺黏液性囊性肿瘤患者的临床资料，根据病理诊断结果分为良性或交界性肿瘤组（70例）和恶性肿瘤组（28例）。分析胰腺黏液性囊性肿瘤的临床症状、病理特点、CT影像学特征，以及与恶性胰腺黏液性囊性肿瘤发生相关的危险因素。结果98例胰腺黏液性囊性肿瘤多好发于围绝经期女性（71．4％，70／98），51．0％（50／98）患者有明显临床症状，多为腹痛腹胀等非特异性表现，黄疸仅见于恶性肿瘤患者。良性或交界性肿瘤多位于胰体尾部，多伴分隔和薄囊壁；恶性肿瘤多位于胰头颈部，且多伴实性成分和厚囊壁。单因素分析结果显示，患者性别、年龄、有无临床症状、有无黄疸、有无体重明显下降、肿瘤部位、边界、囊壁厚度、有无实性成分、有无主胰管扩张与恶性胰腺黏液性囊性肿瘤的发生有关（均P〈0．05）。多因素分析结果显示，厚壁和伴实性成分是恶性胰腺黏液性囊性肿瘤发生的独立预测因素（OR分别为31．417和34．976，均P〈0．05）。结论患者性别、年龄、有无临床症状、有无黄疸、有无体重下降、肿瘤部位、边界、有无主胰管扩张、囊壁厚度和有无实性成分为诊断恶性胰腺黏液性囊性肿瘤的重要指标，其中厚壁和伴实性成分为恶性胰腺黏液性囊性肿瘤的独立危险因素。

Objective To evaluate the clinicopathological and CT features of mucinous cystic neoplasms （MCNs） of the pancreas and analyze the correlative risk factors for malignant pancreatic mucinous cystic neoplasms. Methods Ninety-eight patients who underwent curative resection for mucinous cystic neoplasms of the pancreas at PLA General Hospital from April 1994 to January 2013 were included in this study. All clinicopathological data available were retrospectively analyzed. All patients were divided into benign tumors ＋ premalignant lesion group （70 patients ） and malignant tumor group （28 patients ）. Clinicopathological and CT features of the mucinous cystic neoplasms of the pancreas and risk factors of malignant pancreatic mucinous cystic neoplasms were analyzed. Results Mucinous cystic neoplasms were seen mostly in perimenopausal women （71.4% , 70/98 cases, ）, and 51.0% （50/98 cases） of the patients had obvious clinical signs, mostly non-specific abdominal pain, but jaundice was present only in cases of malignant mucinous cystic neoplasms. Benign mucinous cystic neoplasms were mostly located in the distal pancreas （74.3%） and characterized with septa and thin cystic wall, while more malignant mucinous cystic neoplasms were located at the proximal pancreas （57.1% ） and characterized with thick cystic wall and solid components. Univariate analysis showed that findings associated with malignancy gender, age ≥ 60, presence of symptoms, jaundice, weight loss, tumor location, margin, wall thickness, solid components and dilation of the main pancreatic duct were significantly correlated with malignant tumor development （ P 〈 0.05 for all）. The results of multiple logistic regression analysis showed that thick wall and solid components were independent prognostic factors for malignancy （ OR = 31. 417 and 34.976, P 〈 0.05 for both ）. Conclusions Gender, age ≥ 60, presence of symptoms, jaundice, weight loss, tumor location, margin, wall thickness, solid components and dilation of the main pancreatic duct are important diagnostic indices ofmalignant mucinous cystic tumors of the pancreas, while thick wall and solid components are independent risk factors of malignant pancreatic mucinous cystic neoplasms.