胰腺腺泡细胞癌的诊治分析

Diagnosis and treatment of pancreatic acinar cell carcinoma

目的 分析胰腺腺泡细胞癌的临床特点及手术效果.方法 回顾性分析1999年至2012年间经复旦大学附属中山医院手术治疗的胰腺腺泡细胞癌患者的临床资料及随访数据.结果 共收治16例胰腺腺泡细胞癌患者,其中男性13例,女性3例,年龄38 -71岁,平均年龄57岁.首发症状腹痛6例,腰背痛3例,腹胀2例,消瘦2例,黄疸2例,黑便1例.CA19-9升高8例,CEA升高3例.术中见肿瘤位于胰腺钩突部1例,胰头9例,胰体尾6例,其中2例侵犯肠系膜上静脉,1例侵犯肝动脉,1例侵犯腹腔干及脾动脉.1例肿瘤无法切除,仅行穿刺活检.另外15例均获得R0切除,其中胰十二指肠切除术10例,包括1例合并肝动脉切除重建,2例合并肠系膜上静脉切除重建;5例行胰体尾＋脾切除术.手术切除标本示肿瘤平均大小为5.7 cm×4.6 cm,12例有包膜包绕,8例见淋巴结转移.15例患者获得随访,术后中位生存时间为21个月,1、3、5年生存率分别为71.4％、28.6％、7.1％.结论 胰腺腺泡细胞癌缺乏特异的临床表现及实验室指标,术前诊断极为困难,手术切除是其首选治疗方案,预后优于胰腺导管腺癌。

Objective To investigate the clinical characteristics and surgical outcomes of pancreatic acinar cell carcinoma （PACC）.Methods The clinical and follow up data of PACC patients treated with surgery in Zhongshan Hospital of Fudan University between 1999 and 2012 were analyzed retrospectively.Results A total of 16 PACC were identified including 13 male and 3 female patients.The age of the patients ranged from 38 to 71 with an average of 57 years old.Six patients presented as abdominal pain,while low back pain in 3 patients,abdominal distention in 2 patients,emaciation in 2 patients,jaundice in 2 patients and melena in 1 patient.Elevated CA19-9 level was observed in 8 patients and 2 patients had elevated serum CEA.The tumors were located in the uncinate process in 1 patient,head in 9,body and tail in 6.The superior mesenteric vein was invaded in 2 cases and 1 patient had hepatic artery invasion.The tumor invaded both the celiac trunk and splenic artery in 1 patient.One patient had just undergone intra-operative needle aspiration biopsy due to unresectable tumor.All the other 15 patients underwent surgical excision with R0 resection.Among the 10 patients received pancreaticoduodenectomy,2 had superior mesenteric vein resection and replacement and 1 had hepatic artery resection.Five patients underwent distal pancreatectomy without spleen preservation.The mean size of these tumors was 5.7 cm ×4.6 cm,12 cases had a surrounding envelope,while lymphatic metastasis was observed in 8 cases.The follow up data of 15 patients were collected and the median postoperative survival was 21 months,and the survival rate of 1,3,5 year was 71.4%,28.6%,7.1%.Conclusions Pre-operative diagnosis of PACC is extremely difficult due to lack of specific clinical features and lab tests.Surgery is the first line treatment for PACC,and the prognosis of PACC is better than that of pancreatic ductal adenocarcinoma.