胰腺囊性疾病的临床诊治分析

Clinical diagnosis and treatment of pancreatic cystic lesions

目的探讨胰腺囊性病变的临床特征和诊治方法。方法选取2016年1月至2017年12月间南京医科大学第二附属医院收治手术治疗的32例胰腺囊性疾病患者的临床资料进行回顾性分析。结果 32例患者中,25例有不同类型、不同程度的临床表现,7例无临床症状。11例假性囊肿患者中8例有确切的胰腺炎病史,6例胰腺导管内乳头状黏液性肿瘤(IPMN)患者中3例有胰腺炎发作史,其他类型均无胰腺炎病史。32例患者中糖类抗原19-9(CA19-9)升高3例,癌胚抗原(CEA)均在正常范围,糖类抗原125(CA125)升高2例。32例患者平均囊肿直径为(5.7±4.8)cm,主胰管扩张4例,囊内有实性成分4例。32例患者术前影像学诊断与术后病理比较,诊断总准确率为56.3%。32例患者均接受手术治疗。行胰十二指肠切除术7例,行胰体尾切除术15例,行囊肿内引流术10例。术后无死亡患者。术后并发症12例(37.5%)。结论胰腺囊性疾病的临床表现无特异性,需结合肿瘤指标和影像学检查等结果进行综合分析,手术治疗总体并发症发生率较高,需重视手术指针,关注手术安全性。

Objective To investigate the clinical diagnosis and treatment of pancreatic cystic lesions. Methods The clinical data of 32 patients with pancreatic cystic lesions undergoing pancreatic surgery who were treated at The Second Affiliated Hospital of Nanjing Medical University from January 2016 to December 2017 were analyzed retrospectively. The perioperative data include general conditions,clinical manifestations,serum tumor markers,imaging features,treatments of patients and surgical complications.Results Among the 32 patients enrolled in the study,25 patients had clinical presence of different degrees and styles and 7 had no symptom. Among the 11 patients wqith pseudocysts,8 had accurate history of pancreatitis and among the 6 patients with IPMN,3 had history of pancreatitis. For the rest types,no history of pancreatitis was identified. Among the 39 patients,CA19-9 increased in 3 patients,CEA remained the same and CA125 increased in 2 patients. All the patients underwent CT or MR enhanced scan inspection.The mean diameter of cystic lesions was（ 5. 7 ± 4. 8） cm. Main pancreatic duct dilatation occurred in 4 patients. According to the imaging diagnostic results,serous cystic neoplasm（ SCN） occurred in 3 patients,mucious cystic neoplasm（ MCN） occurred in 2 patients,intraductal papillary mucious neoplasm（ IPMN）occurred in 4 patients,solid pseudopapillary neoplasm（ SPN） occurred in 1 patient and pancreatic pseudocyst occurred in 8 patients,which were consistant with the results of postoperative pathology tests. The overall diagnosis rate was 56. 3%. All the 32 patients underwent surgery among which,7 underwent pancreaticoduodenectomy,15 underwent distal pancreatectomy and 10 underwent internal drainage. No perioperative deaths occurred,and the overall complication rate was 37. 5%（ 12 patients）. Postoperative pancreatic fistula occurred in 9 patients,and 15 patients underwent distal pancreatectomy and 10 underwent internal drainage of pancreatic cyst. No postoperative death occurred. Complicaiton occurred in 12 patients（ 37. 5%）. Postoperative pancreatic fistula occurred in 9 patients,including 6 with distal pancreatectomy and 3 with pancreatoduodenectomy. Conclusion Pancreatic cystic lesions have no special and typical clinical manifestations,which should be comprehensively analyzed by considering the tumor markers and imaging tests. The overall complications were high and more attention should focused on surgical indication and operation safety.