15例胰腺腺泡细胞癌诊治分析

Diagnosis and treatment analysis of 15 pancreatic acinar cell carcinoma patients

目的：分析胰腺腺泡细胞癌的临床特点及诊治经过,以期指导临床,改善患者预后。方法：回顾分析天津医科大学肿瘤医院1994年12月至2014年3月收治的15例胰腺腺泡细胞癌患者资料,分析其临床病理、治疗及预后特征。结果：15例患者中,男8例,女7例,发病中位年龄44岁。肿瘤位于胰头部8例,胰体尾部6例,钩突部1例。肿瘤直径3~18 cm,平均直径6.67 cm。患者出现黄疸者少,肿瘤标志物多不升高。出现术前转移者6例,12例行根治性切除,3例行保守治疗。术前及术中均不能正确诊断,最终诊断需要靠术后病理或穿刺,行抗胰蛋白酶、抗糜蛋白酶检测均阳性。术后化疗多以吉西他滨为基础。平均生存期20.6个月。结论：胰腺腺泡细胞癌临床特点比较特殊,且现倾向于认为其属于低度恶性肿瘤,应积极治疗。

Objective： To discuss the clinical feature, diagnosis, and treatment course of pancreatic acinar cell carcinoma（ACC） to guide clinical practice and improve prognosis of patients. Methods： Clinical data of 15 patients with pathologically confirmed pancreatic acinar cell carcinoma between December 1994 and March 2014 in Tianjin Medical University Cancer Institute and Hospital were retrospectively studied. Results： The patients include eight males and seven females with a median age of 44. Tumors in these patients appeared in different parts of the pancreas. Eight patients had tumor in the head, six in the body and tail, and one in the uncinate process. The tumor size ranged from 3 cm to 18 cm, with an average diameter of 6.67 cm. The patients presented less jaundice and the tumor markers remained constant, specifically, no increase was reported. Six patients had metastasis before their operation. Twelve patients received radical resection,while the other three received palliative treatment. The preoperative and intraoperative diagnoses were not exact. The final diagnosis depended on pathologic confirmation after surgery or puncture. The immunohistochemical results of trypsin and chymotrypsin were positive in the patients who were examined. The postoperative chemotherapy was usually based on gemcitabine. The average survival time was 20.6 months.Conclusion： Pancreatic acinar cell carcinoma has special clinical features, and clinicians tend to regard it as low-grade malignancy. The attitude towards ACC should be positive.