胰腺实性假乳头状瘤的诊断和治疗

Diagnosis and treatment of solid pseudopapillary tumor of the pancreas

目的:总结胰腺实性假乳头状瘤(solid pseudopapillary tumor of pancreas,SPTP)的诊断和治疗经验.方法:回顾性分析中国人民解放军总医院2002-02/2013-07诊治的134例SPTP病例的临床资料.结果:女116例,男18例,中位年龄29岁;肿瘤位于胰头40例(占29.85%),胰体尾及胰尾部64例(47.76%),颈部17例(12.69%);肿瘤体积较大,中位长径6.0 cm;21例(15.67%)因触及上腹包块就诊,上腹部隐痛不适50例(37.31%),49例无症状(36.57%).超声表现为胰腺低回声实性或囊实性占位.计算机断层扫描(computed tomography,CT)、磁共振成像(magnetic resonance imaging,MRI)发现胰腺低密度占位性病变,增强扫描实性部分渐进性强化,强化程度低于正常胰腺,囊性成分不强化.126例行手术治疗.随访89例,4例复发转移死亡,1例未行手术治疗的患者病情较前进展,其余均未发现肿瘤复发转移.结论:SPTP好发于年轻女性,具有恶性潜能,其临床表现缺乏特异性,术前诊断主要依赖影像学检查,手术切除是首选治疗方法,预后好.

AIM： To summarize the experience of diagnosis and treatment of solid pseudopapillary tumor of the pancreas（SPTP）.METHODS： Clinical data for 134 SPTP patients admitted to Chinese PLA General Hospital from February 2002 to July 2013 were retrospectively analyzed.RESULTS： The median age of the patients（116 females and 18 males） was 29.7 years（range 9-71 years）. The tumor was located in the pancreatic head in 40 patients, in the pancreatic neck in 17 patients, in the pancreatic body and tail in 64 patients. The size of the lesions was large, and the median diameter of tumors was 6.0 cm（1.5-21.0 cm）. Clinical presentation included a palpable abdominal mass in 21 patients, abdominal pain in 50 patients. Fortynine patients were asymptomatic, and their tumors were found incidentally on abdominal sonographic examination for other reasons. Low- echo solid and solid-cystic masses were found in the pancreas by ultrasonic examinations. Computed tomography（CT） or magnetic resonance imaging（MRI） found lowdensity masses in the pancreas. After dynamic contrast-enhanced scanning, the solid parts of the lesion showed progressive enhancement and the cystic parts of the lesion showed no enhancement. One hundred and twenty-six patients were treated by surgery. Of 89 patients who were followed, 4 died of tumor relapse and metastasis and the condition of one patient who did not undergo operation progressed, while no evidence of relapse or metastasis was found in other patients.CONCLUSION： SPTP occurs more frequently in young females and is potentially malignant. There is no characteristic clinical presentation. Preoperative diagnosis of SPTP depends on imaging study such as CT and MRI. Surgical resection is the first choice of treatment and is associated with a satisfactory prognosis.