非肿瘤性胰腺真性囊肿21例诊治体会  

Diagnosis and treatment of 21 cases of non-neoplastic genuine pancreatic cyst.

作　　者：王益林[1] 雷若庆[1] 郭滟[2] 陈泉宁[1] 杨文洁[3] 许志伟[1] 邓漾[1] 费健[1] 王建承[1] 吴卫泽[1] 彭承宏[1] 张圣道[1] 

机构地区：[1]上海交通大学附属瑞金医院普外科,上海 200025 [2]上海交通大学附属瑞金医院病理科,上海 200025 [3]上海交通大学附属瑞金医院放射科,上海 200025

出　　处：《胰腺病学》2007年第3期163-166,共4页Chinese JOurnal of Pancreatology

摘　　要：目的探讨非肿瘤性胰腺真性囊肿的诊断和治疗。方法回顾性分析1999年6月至2006年9月收治的21例非肿瘤性胰腺真性囊肿患者的临床病理资料及随访结果。结果21例患者中，男3例，女18例，男女比例1：6；年龄24～77岁，平均47岁。12例无任何症状和体征，9例有症状。实验室检查均未见异常。行B超、ERCP、CT、MRI检查分别有21例、5例、21例和4例，诊断准确率分别为0％、40％、19％和50％。20例行手术治疗，1例行剖腹探查、活组织检查。5例术后出现胸腔积液，其中3例并发胰瘘，经治疗后痊愈出院。病理检查浆液性囊肿15例、潴留性囊肿3例、黏液性囊肿2例、淋巴上皮样囊肿1例。本组2例失访，19例获随访，随访时间8个月～7年，除1例因脑出血死亡，其余均健在，无复发。结论非肿瘤性胰腺真性囊肿好发于中年女性，无特征性临床表现，术前诊断准确率较低。对无症状患者不需手术治疗。有症状的、且影像学上不能与囊性肿瘤鉴别或随访期囊肿有增大趋势者宜手术治疗。Objective To investigate the diagnosis and treatment of non-neoplastic genuine pancreatic cystic. Methods The clinical and pathologic characteristics of 21 patients with non-neoplastic genuine pancreatic cystic confirmed by pathology were retrospectively analyzed. Results Among the 21 patients, there were three male and eighteen female patients with a median age of 47 years （range, 24 - 77 years）. Twelve of the patients were asymptomatic and the other nine patients were symptomatic. Laboratory findings in these 21 patients were unremarkable. All the patients underwent computed tomography （CT） and ultrasound investigation, and the diagnostic accuracy were 19% and 0%, respectively; 5 patients and 4 patients underwent ERCP and MRI, and the diagnostic accuracy were 40% and 50%, respectively. Twenty patients were treated surgically. One patient underwent exploratory laparotomy with biopsy. Postoperative pleural effusion occurred in five cases, pancreatic fistula in three cases. All these patients fully recovered after conservative treatment. Pathologic evidence suggested serous cystadenoma （SCN） in 15 patients, retention cysts in 3, mucinous cystic neoplasms （MCN） in 2, lymphoepithelial cyst in 1. Of all the 21 patients, 2 patients were lost during the follow-up, the followup of the remaining nineteen patients ranged from 8 months to 7 years, one patient died for cerebral heraorrhage and eighteen are still alive without recurrence. Conclusions Non-neoplastic pancreatic genuine cysticpredominantly occurred in middle aged women, with nonspecific clinical manifestation. The preoperative diagnostic accuracy was low. It is not necessary to surgically treat those patients without symptom. Surgical resection is indicated only when the cyst is symptomatic or could not be differentiated from MCN and IPMN. or increases in size during follow-up.

关 键 词：胰腺囊肿 诊断 治疗 

分 类 号：R657[医药卫生—外科学]