胰腺小囊性占位临床诊治分析

Differential diagnosis of asymptomatic patients with pancreatic small cystic lesions

目的总结分析良性与潜在恶性胰腺小囊性占位的临床病理特点及鉴别诊断。方法回顾性分析胰腺小囊性占位患者的临床病理资料。根据病理结果，分为良性组（浆液性囊腺瘤、淋巴上皮囊肿及假性囊肿）及潜在恶性组（黏液性囊腺瘤、导管内乳头状瘤及实性假乳头状瘤），比较两组临床资料的差异。结果共有46例胰腺小囊性占位经手术获得病理结果。良性组22例。潜在恶性组24例。在影像学特点上，潜在恶性组CT表现为壁厚〉2mm（P=0．000）、囊壁结节（P=0．000）、囊内实性成分（P=0．001）、囊壁强化（P=0．003）以及囊壁厚度不均匀（P=0．024）的比例均显著高于良性组。其诊断潜在恶性疾病的敏感性、特异性和准确性分别为91．7％、77．3％和84．8％。结论胰腺小囊性占位影像学检查中发现的囊壁结节、强化、壁厚〉2mm、壁厚薄不均以及囊内实性成分等征象有助于其良恶性的鉴别诊断。

Objective To analyze the differences between benign and potential malignant small pancreatic cystic lesions. Methods We retrospectively analyzed the clinical and pathological data of asymptomatic patients with pancreatic small cystic lesions and divided them into benign group （including serous cystic neoplasms, lymphoepithelial cyst and pseudocyst） and potential malignant group （including mucinous cystic neoplasms, intraductal papillary mucinous neoplasms and solid pseudopapillary neoplasms）. Comparison of clinical data was made between the two groups. Results 46 patients with pathological results were included （22 cases in benign group and 24 cases in potential malignant group）. No difference was detected on demographic data and lab results between the two groups. Compared with benign patients, patients in the potential malignant group were more likely to show thicken wall （ P = 0. 000） , mural nodule （ P = 0. 000）, solid constituents inside the cyst （ P = 0. 001 ）, wall enhancement （ P = 0. 003 ） and uneven wall on CT scan （ P = 0. 024 ）. The diagnostic sensitivity, specificity and accuracy of the combination of above mentioned CT features for potential malignant diseases were 91.7%, 77.3% and 84. 8%, respectively. Conclusions Pancreatic cystic lesions with thicken wall, mural nodule, wall enhancement, solid parts inside the cyst and uneven wall on CT were more likely of potential malignant entities.