儿童胰腺肿瘤的临床诊治分析

Pancreatic tumors in children:diagnosis and treatment

目的探讨儿童胰腺肿瘤的诊断及治疗策略。方法回顾性分析2015年3月至2020年9月重庆医科大学附属儿童医院收治的18例胰腺肿瘤患儿的临床资料,其中男性8例,女性10例,年龄3个月~14岁11个月,中位年龄8岁2个月。收集患儿的年龄、性别、病理资料、手术方式、化疗情况、肿瘤位置、治疗结局等临床资料。以门诊复查及电话回访的方式随访。结果所有患儿均行腹部超声、增强CT和/或MR检查,均发现胰腺囊实性或实性病变,均在气管插管全麻下行开腹手术治疗,均顺利完成手术。18例患儿中,胰腺实性假乳头状瘤11例,胰母细胞瘤(PBL)7例。肿瘤位于胰头部13例(行Whipple术3例,行保留十二肠胰头切除术1例,行胰腺肿瘤切除术9例);肿瘤位于胰体尾部5例(行保留脾脏的胰体尾部切除术3例,行胰腺肿瘤切除术2例)。3例患儿由于肿瘤巨大(其中1例伴有双肺、左锁骨上窝淋巴结、腹膜后淋巴结转移),取活检证实为PBL后,予以新辅助化疗后手术完整切除肿瘤,3例患儿术后病理显示均为PBL,按要求予以系统化疗。术后发生胰瘘1例,乳糜瘘1例,均通过保守治疗顺利出院。术后随访2~7年,均无瘤生存。结论儿童胰腺肿瘤术前通过B超、CT及MRI不难定位诊断,需术后病理确诊。保留功能的手术切除是儿童胰腺肿瘤的首选治疗方法。

Objective To study the strategies in the diagnosis and treatment of pancreatic tumors in children.Methods The clinical data of 18 children with pancreatic tumor managed at the Children's Hospital Affiliated to Chongqing Medical University from March 2015 to September 2020 were retrospectively studied.There were 8 males and 10 females,age ranged from 3 months to 14 years and 11 months,with a median age of 8 years and 2 months.Clinical data including age,gender,pathological data,surgical methods,chemotherapy,tumor location and treatment outcomes were collected.Follow-up was conducted by outpatient visits and by telephone.Results Abdominal ultrasound,enhanced CT and/or MRI examinations were performed on all these patients,with findings of either a cystic or solid lesion of pancreas.All patients were treated by laparotomy under endotracheal intubation and general anesthesia.The operations were all completed successfully.Among the 18 patients,there were 11 patients with solid pseudopapillary tumors and 7 patients with pancreatoblastoma(PBL).The tumors were located in the head of the pancreas in 13 patients(including 3 patients who underwent pancreaticoduodenectomy,1 patient who underwent resection of the head of the pancreas with preservation of the duodenum,and 9 patients who underwent resection of the tumors).The tumors were located in the body and tail of the pancrease in 5 patients(including 3 patients who underwent resection of the body and tail of the pancreas with preservation of spleen,and 2 patients who underwent resection of tumors).Because of huge tumors,1 patient had bilateral lung,left supraclavicular fossa lymph node and retroperitoneal lymph node metastasis,3 patients were confirmed to have PBL by biopsy,and these tumors were resected completely after neoadjuvant chemotherapy.Postoperative pathology showed that all the 3 patients had PBL and were given systematic chemotherapy.Postoperative pancreatic fistula occurred in 1 patient and chylous fistula in another patient,both were discharged home successfully after conservative treatments.All patients were followed-up for 2-7 years,and all children were tumor-free.Conclusion It is not difficult to diagnose pediatric pancreatic tumors by ultrasound,CT and MRI before operation,and postoperative pathology was needed to confirm the diagnosis.Function-preserving surgical resection was the treatment of choice for pancreatic tumors in children.