胰腺假乳头实体上皮瘤的诊断和治疗  

The diagnosis and treatment of solid-pseudopapillary tumors of the pancreas

作　　者：周光文[1] 陈曦[1] 彭承宏[1] 李宏为[1] 

机构地区：[1]第二医科大学附属瑞金医院外科,上海200025

出　　处：《中华普通外科杂志》2005年第3期140-142,共3页Chinese Journal of General Surgery

摘　　要：目的　探讨胰腺假乳头实体上皮瘤的诊断和治疗方法。方法　回顾性分析我院自1994年6月至2 0 0 3年6月收治的2 1例胰腺假乳头实体上皮瘤患者的临床资料。结果　本组中13例以腹痛为主要表现,7例可扪及腹块。影像学检查未能明确诊断。12例肿瘤位于胰头,9例位于胰体尾部。肿瘤平均直径9 5 (3～2 0 )cm。1例合并肝转移。12例胰头肿瘤中4例行胰十二指肠切除术,8例行肿块切除术;9例胰体尾部肿瘤均行胰腺体尾部加脾切除术。14例术中冰冻病理诊断明确,另有3例免疫组化染色结果报告为胰岛素瘤或其他恶性肿瘤,最终由病理切片及免疫组化染色结果明确诊断。免疫组化染色报告15例NSE染色中14例阳性,10例Vimentin染色中8例阳性,8例PAS染色中7例阳性,细胞角蛋白、上皮膜抗原及嗜铬颗粒素A均阴性。18例获随访,中位随访时间2 4 (1～6 0 )个月,均无瘤存活。结论　对年轻女性出现的胰腺巨大肿瘤应高度怀疑胰腺假乳头实体上皮瘤。积极的手术治疗能获得良好的预后。Objective To evaluate the clinical diagnosis and management of solid-pseudopapillary tumors of the pancreas.Methods A retrospective clinical analysis was made on 21 cases of solid-pseudopapillary tumors of the pancreas admitted from June 1994 to June 2003.Results Abdominal pain was the major complains in 13 cases , 7 cases had palpable abdominal mass.Imaging examination can show the abdominal mass clearly, but diagnosis can not be defined.There were 12 cases whose tumors were located in pancreatic head (4 underwent Whipple procedures and 8 tumor enucleations) and 9 cases with tumors in pancreatic tail (all underwent body and tail resection plus splenectomy).The average diameter of tumor was 9.5 cm (3-20).One case had liver metastasis.Diagnosis was proved by frozen pathology during operation in 14 cases, and other 3 cases initially diagnosed as insulinomas and other malignant tunors, had definite diagnosis by postoperative paraffin section and enzyme labeling.Enzyme labeling examinations showed that there were 14 cases of NSE positive in 15 cases, 8 cases of Vimentin positive in 10 cases and 7 cases of PAS positive in 8 cases.CK, EMA and CHG A were negative.Eighteen cases were followed up (85.7%) with a median period of 24 months(1～60) without tumor recurrence.Conclusion Huge pancreatic masses of pancreas in young females should suggest the diagnosis of solid-pseudopapillary tumors.Aggressive surgical therapy can result in good prognosis in these patients.

关 键 词：上皮瘤 诊断和治疗 实体 乳头 胰十二指肠切除术 Vimentin 免疫组化染色 2003年6月 胰体尾部肿瘤 冰冻病理诊断 嗜铬颗粒素A 1994年 回顾性分析 影像学检查 肿块切除术 胰腺体尾部 PAS染色 细胞角蛋白 上皮膜抗原 治疗方法 临床资料 主要表现 平均直径 胰头肿瘤 

分 类 号：R735.9[医药卫生—肿瘤]