胰腺囊腺瘤与囊腺癌的临床特点及其鉴别诊断  

Clinical characteristics and differential diagnosis of pancreatic cystadenoma and cystadenocarcinoma

作　　者：周静[1] 陶京[1] 王春友[1] 刘涛[1] 

机构地区：[1]华中科技大学附属协和医院胰腺外科中心,武汉430022

出　　处：《中华普通外科杂志》2007年第7期497-499,共3页Chinese Journal of General Surgery

摘　　要：目的探讨胰腺囊腺瘤与囊腺癌的临床特点及鉴别点。方法回顾性分析23例胰腺囊腺瘤与囊腺癌患者的临床表现,实验室检查,影像学资料以及病理学结果。结果2000年1月至2005年12月我院共收治胰腺囊实性肿瘤23例,其中囊腺瘤16例,囊腺癌7例。本院首诊19例中术前误诊为胰腺假性囊肿3例,误诊为胰体尾癌1例,另有2例术前诊断为胰腺囊腺瘤,术中探查结合快速冰冻切片诊断为恶性,误诊率为31.6%（6/19）;另4例在外院行囊肿内引流手术后病情加重,转入我院手术证实为胰腺囊腺瘤3例,胰腺囊腺癌伴肝转移1例。本组病例主要临床表现为腹痛、腹胀,体重下降,贫血和低蛋白血症等。术前血清肿瘤标志物的敏感性仅为41.7%。CT在浆液性和黏液性囊性肿瘤的鉴别中的价值有限,其诊断正确率仅43.5%（10/23）。7例黏液性囊腺癌中3例术中冰冻切片判断为良性。结论胰腺囊腺瘤与囊腺癌的误诊率较高,影像学检查有助于诊断,最终诊断需要依赖病理学检查。Objective To discuss the-clinical characteristics and differential diagnosis of pancreatic cystadenoma and cystadenocarcinoma. Methods Clinical data of 23 patients with pancreatic cystadenoma or cystadenocarcinoma admitted in our hospital from Jan 2000 to Dec 2005 were retrospectively analyzed. Result This study included 16 cases of cystic adenoma and 7 cases of cystadenocarcinoma. Six cases initially admitted into our hospital were misdiagnosed preoperatively （ three cases were misdiagnosed as pancreatic pseudocysts,one case as carcinoma of the body and tail of the pancreas, two cases misdiagnosed for benign cystic adenoma）. The other four cases initially misdiagnosed as pancreatic pseudocyst undergoing internal drainage in other hospitals were proved to be with cystic adenoma （3 cases ） and pancreatic cystadenocarcinoma with hepatic metastasis （ 1 case） in our hospital. The most common complaints were upper abdominal pain and distension, weight loss, anemia and hypoproteinemia. Tumor markers＇ sensitivity was 41.7%. CT scan lacked specificity in differential diagnosis between serous cystic adenoma and mucinous cystic adenoma. The diagnosis rate was 43.5% （ 10/23 ）. Intraoperative frozen pathologic section misdiagnosed as serous cystic adenoma in three out of 7 cases of cystadenocarcinoma. Conclusion Pancreatic cystadenoma and cystadenocarcinoma are diseases with high rate of misdiagnosis, Imageing may provide additional information, but final diagnosis depends on pathology.

关 键 词：胰腺肿瘤 囊腺瘤 囊腺癌 诊断 鉴别 

分 类 号：R686[医药卫生—骨科学]