胰腺黏液性囊性肿瘤125例临床特征分析

Mucinous cystic neoplasm of the pancreas： clinical features of 125 patients

目的 分析胰腺黏液性囊性肿瘤（MCN）的临床特征,提高对该疾病的认识.方法 采用单中心回顾性研究,分析上海长海医院2000年1月至2013年12月期间手术治疗的125例MCN的临床资料,总结其临床特征.结果 125例MCN中,女性112例,男性13例,女：男为8.6：1,年龄25 ～ 77岁,平均（48 ±14）岁.38例（30.4％）患者无症状,87例（69.6％）有症状,以腹痛最常见（81.6％）.肿瘤位于胰体尾部111例（88.8％）,肿块平均直径（6.3±3.4）cm（1～ 20 cm）.85例（68.0％）为多房结构.均不与胰管相通.术前影像学检查正确诊断率为27.2％.15例MCN在内镜超声引导下细针穿刺行细胞或组织病理学检查,其中14例（93.3％）囊液CEA＞800 μg/L.手术方式以胰体尾切除术为主,共102例（81.6％）.组织病理学分级示MCN伴轻-中度异型增生110例（88.0％）,伴重度异型增生2例（1.6％）,伴浸润性癌13例（10.4％）.非浸润性MCN术后2、5年生存率均为100％,浸润性MCN术后2、5年生存率均为54.0％.结论 MCN主要发生在中年女性,多位于胰腺体尾部,腹痛为主要症状,术前诊断较为困难,治疗以手术为主,非浸润性MCN可治愈.

Objective To analyze the clinical features of mucinous cystic neoplasm （MCN） of pancreas and to improve our understanding of MCN.Methods The clinical data of one hundred and twentyfive patients with MCN who underwent surgical treatment at Changhai Hospital between January 2000 and December 2013 were retrospectively analyzed.Results Among the 125 cases of MCN,the vast majority were female （n =112,89.6％）,and only 13 patients were male ; and the mean age was 48 （range,25-77） years old.Thirty-eight （30.4％） patients presented without symptom,while 87 （69.6％） were symptomatic,and abdominal pain was the most common symptom （81.6％）.MCNs were located predominantly in the body or tail of the pancreas （n =111,88.8％） and had a mean size of 6.3 cm （range,1-20 cm）.About 68.0％ of MCNs were multilocular and none was communicated with pancreatic duct.The preoperative diagnostic accuracy was 27.2％.Fifteen cases underwent FNA,and the fluid CEA ＞ 800 ng/ml was detected in 14 cases （93.3％）.The most common surgical procedure performed for MCNs was distal pancreatectomy （n =102,81.6％）.Histologically,110 （88.0％） had low-or intermediate-grade dysplasia,2 （1.6％） had high-grade dysplasia,and 13 （10.4％） had invasive carcinoma.The 2-year and 5-year survival rate for non-invasive MCNs were 100％,while the 2-year and 5-year survival rate for MCNs with invasive carcinoma was about 54.0％.Conclusions Patients with MCN are predominantly middle aged women,the lesions are mainly located in the body and tail of the pancreas,abdominal pain is the most common symptom,and the correct preoperative diagnosis is difficult.Surgical resection should be performed for all surgically fit patients and is curative for noninvasive MCNs.