胰腺囊性肿瘤的诊断与治疗

Diagnosis and treatment of pancreatic cystic neoplasms

目的 探讨胰腺囊性肿瘤患者不同诊治方案的风险和获益.方法 回顾性研究近年来诊治的243例胰腺囊性肿瘤患者的临床资料,根据肿瘤部位、大小、侵袭范围等判断有无手术指征并选择手术方式.对无手术指征患者门诊随诊,定期复查,根据病灶进展状况决定是否手术治疗并评估预后;对手术切除的患者分别评价其手术指征、术式选择、并发症及预后等情况.结果 门诊随访胰腺良性囊性肿瘤患者共58例,均获长期生存,其中因肿瘤进展行手术治疗4例,术后病理均为良性.直接手术治疗185例,切除率为97.3％（180/185）,其中非侵袭性肿瘤127例,侵袭性肿瘤58例.围手术期死亡2例,出现并发症41例（22.1％）,胰瘘是围手术期主要并发症,发生率与肿瘤部位及切除范围相关.非侵袭性肿瘤术后均获长期生存,侵袭性肿瘤患者术后1、3、5年生存率分别为89.6％、52.1％和29.2％.结论 胰腺囊性肿瘤的诊治极具复杂性,无症状的良性肿瘤患者可随访观察,手术治疗特别是肿物局部切除应严格掌握指征,恶性肿瘤应选择肿瘤根治术,晚期患者可尝试联合脏器切除.

Objective To investigate the risks and benefits of different surgical treatments for cystic neoplasms of the pancreas （CNP）.Methods The clinical data of 243 CNP patients were reviewed retrospectively.Different surgical treatments were adopted according to the site,size and invasiveness of the tumors.A long term follow-up was carried out for patients with small benign CNP,and a surgical excision is proposed if tumors progressed during the observation.Results 58 outpatients with no evidence of malignancy was followed up and had long-term survival,in which 4 patients received a surgical resection in case of tumor progression,and all of them were confirmed benign tumors.185 cases received surgical treatments,with a resection rate of 97.3％ （180/185）,including 127 non-invasive tumors,and 58 cases of invasive tumors.Perioperative mortality was 2/185,and morbidity rate was 41/185.Pancreatic fistula was the most frequent complication,which was significantly associated with tumor site and excision extension.All patients with non-invasive CNP acquired a long term survival after surgical treatments.The postoperative 1,3,5 year survival rates for patients with invasive lesions were 89.6％,52.1％ and 29.2％,respectively.Conclusions Long term follow-up and observation is feasible for asymptomatic patients with benign CNP.A radical resection should be performed for malignancy,and a combined multi-organ resection may improve the prognosis for local advanced tumors.