儿童保留脾脏的胰体尾肿瘤切除术近期并发症及远期疗效分析

Short-term complications and long-term outcomes of spleen-preserving distal pancreatectomy in pediatric pancreatic tumors

目的分析儿童保留脾脏的胰体尾肿瘤切除术近期并发症及远期疗效.方法回顾性收集2007年1月至2018年1月我院诊治的43例儿童胰体尾肿瘤患儿临床信息并进行随访.结果男17例(39.53%)、女26例(60.47%),中位发病年龄为123(80,141)个月,初诊时原发肿瘤最大径中位数为7.60cm;术后病理显示,实性假乳头状瘤28例(65.12%)、胰母细胞瘤10例(23.26%)、胰腺内分泌肿瘤4例(9.30%)及胰腺单纯囊肿1例(2.33%)。2例(4.65%)行肿瘤局部剜除术,4例(9.30%)行切除脾脏的胰体尾肿瘤切除术,37例患儿(86.05%)接受保留脾脏的胰体尾肿瘤切除术。本组43例患儿中,共16例(37.21%)出现术后近期并发症,包括胰痿(13例)、胃排空延迟(3例)、腹腔感染(7例)、术后出血(2例)。中位随访时间为46(23,71)个月,38例患儿(88.37%)无病生存;2例(4.65%)肿瘤复发后存活;1例胰母细胞瘤患儿(2.33%)术后迅速出现肿瘤复发而死亡;2例(4.65%)失访.40例患儿中共3例(3/40,7.50%)出现远期并发症,包括慢性脂肪泻(2例),低血糖发作(1例)。本组患儿中共3例因肿瘤复发接受二次手术(分别为胰母细胞瘤和胰腺实性假乳头状瘤),结论保留脾脏的胰体尾肿瘤切除术在儿童胰体尾肿瘤治疗中安全可行,疗效确切。

Objective To analyze the short-temi complications and long-term outcomes of spleenpreserving distal pancreatectomy ( SPDP) in pediatric pancreatic tumors. Methods A retrospective analysis was conducted on 43 patients with tumors of the body and tail of the pancreas in Beijing Children's Hospital from Jan 2007 to Jan 2018. Results There were 17 boys (39. 53%) and 26 girls ( 60.47%), with a median age of 123 ( 80, 141 ) months. The median maximum diameter of primary tumor was 7. 60 cm. Diagnoses included solid pseudopapillary tumor ( n = 28 ), pancreatoblastoma (n = 10), neuroendocrine tumor (n = 4), and pancreatic cyst (n=1). Two cases ( 4.65%) received tumor enucleation, 4 cases (9. 30%) did distal panereatectomy plus splenectomy, and 37 cases ( 86. 05%) did SPDP. 16 cases (37.21 %) had short-term complications, including pancreatic fistula (n=13), delayed gastric emptying ( n = 3 ), abdominal infection ( n = 7 ) and postoperative bleeding (n=2). After a median follow-up of 46 (23 , 71) months, 38 cases (88. 37%) were disease-free;two cases (4. 65%) with tumor recurrence;one case of pancreatoblastoma died of tumor recunence. Two cases lost to follow-up. Three patients had long-term complications, including chronic fatty diarrhea ( n = 2 ) and hypoglycemia ( n = 1 ). Three patients underwent second operation for recurrent tumor ( one pancreatoblastoma and two solid pseudopapillary tumor). Conclusions SPDP is safe and effective in the treatment of tumors of the body and tail of the pancreas in children.