胰腺囊腺瘤和囊腺癌的诊治

Diagnosis and treatment of cystoadenoma and cystoadenocarcinoma of the pancreas

目的 探讨胰腺囊性肿瘤的诊断和治疗。方法 对 1978～ 1998年收治的均经手术和病理检查证实为胰腺囊性肿瘤的 11例临床资料进行回顾性分析。结果 胰腺囊性肿瘤好发于中青年女性 ,临床表现为病程较长的上腹部肿物和胀痛。钡餐、B超、CT及ER CP能协助诊断。本组 11例中行胰十二指肠切除 2例 ,胰体尾加脾切除 6例 ,肿瘤单纯切除2例 ,囊肿 空肠袢式吻合 1例 ,手术切除率为 90 .9%。术后 1例死于腹内感染并败血症。术后存活的 10例均获随访 (10 0 % )。 1例胰腺囊腺瘤手术后 3个月死于心肌梗死 ,1例胰腺囊腺癌术后 4年 3个月死于癌转移 ,其余均健在。结论 凡中青年女性 ,上腹或左上腹出现较大肿块 ,且病程较长 ,结合B超和CT检查可对本病的诊断。胰腺囊腺瘤或囊腺癌 ,癌体虽较大 ,均有完整的包膜 ,而易于分离切除 ,首选手术方式为包括部分胰腺组织的全肿瘤切除术 。

Objective To investigate the diagnosis and treatment of cystic adenoid tumor of the pancreas. Methods Retrospective analysis was made on the clinical data of 11 cases of pancreatic cystic neoplasms confirmed by operation and pathology at our hospital from 1978 to 1998. Results Cystic adenoid tumor of the pancreas is more likely to occur in young females with middle age, clinical presentations were as follows: a long-term persistent mass and distending pain in the epigastrium. Utrasounography, CT and ERCP could contribute to the diagnosis. Of the 11 cases, pancreaticoduodenectomy was performed in 2, distal pancreatectomy and splenectomy in 6, local excision of the mass in 2, and loop type cystojejunostomy in 1. The rete of resection was 90.9%. Of them, 1 case died of abdominal abscess and septicemia postoperatively. All the 10 cases who survived postoperatively were followed up. Among the 10 cases, 1 case of pancreatic cystoadenoma died of cardiac infarction 3 months after operation, and 1 case of cystoadenocarcinoma died of metastasis 51 months after tumor excision. The other 8 cases still alived well now. Conclusions Cystic tumor of the pancreas should be suspected when young or middle aged female patients have a long term big mass in epigastrium or left upper quadrant. Ultrasonography and CT scan are helpful in the diagnosis of the tumor including cystoademoma and cystoadenocarcinoma, Although the volume of the tumors may be very big, they often have a intact capsure,so easy to excise. The excision of the total tumor and some arounding pancreatic tissue is the first choice of the treatment for cystic tumor of the pancreas, and the curative effectiveness is satisfctory.