胰腺囊性肿瘤126例外科诊治分析  

Diagnosis and treatment of pancreatic cystic neoplasms： clinical analysis of 126 cases

作　　者：邹忠东[1] 张再重[1] 姚和祥[1] 王烈[1] 

机构地区：[1]南京军区福州总医院普通外科南京军区普通外科研究所,350025

出　　处：《中华肝胆外科杂志》2013年第12期891-894,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：福建省自然科学基金（2006J0372）

摘　　要：目的总结胰腺囊性肿瘤外科诊治经验。方法回顾性分析2003年1月至2012年12月本院收治的126例胰腺囊性肿瘤患者的临床和病理资料。结果患者无特异性临床表现，腹部超声、cT和MRI诊断的正确率分别为90．8％（109／120）、93．4％（114／122）和96．3％（103／107）。126例均查血清肿瘤标记物，CAl9-9升高18例（14．3％），CEA升高10例（7．9％）。开放手术105例，腹腔镜手术21例。肿瘤局部摘除术11例（含腹腔镜手术5例），胰腺节段切除术5例，保留脾脏的胰体尾切除术30例（含腹腔镜手术10例），胰体尾及脾切除术26例（含腹腔镜手术6例，联合肝部分切除术1例，联合胃、结肠切除术1例），保留十二指肠的胰头切除术4例，保留幽门的胰头十二指肠切除术5例，胰头十二指肠切除术38例（含4例联合门静脉和／或肠系膜上静脉切除人工血管重建术），全胰切除术2例，剖腹探查术及肿瘤活检术5例。126例中，围手术期死亡1例，术后胰瘘（B、C级）发生率为12．7％，术后出血（B、c级）发生率为7．1％。114例患者获得随访。随访6～72个月不等，中位随访时间52．4个月。总体5年生存率为80．5％。其中非浸润性肿瘤术后5年生存率为96．4％，浸润性肿瘤术后5年生存率为40．7％。结论大多数胰腺囊性肿瘤为良性，部分为恶性或有恶变及转移潜能。无临床症状且较小的良性肿瘤可严密随访。有临床症状或有恶性征象者应积极手术治疗。非浸润性肿瘤宜选择功能保留性手术，浸润性肿瘤应做规则性胰腺切除并区域淋巴结清扫，必要时行联合脏器切除。Objective To summerize our experience in the diagnosis and treatment of pancreatic cystic neoplasms. Methods A retrospective analysis was conducted on the clinical data of 126 patients with pancreatic cystic neoplasms seen between January 2003 and December 2012 in the Fuzhou General Hospital. Results There was no special clinical manifestation in this series of 126 patients with pan- creatic cystic neoplasms. The diagnostic accuracies of ultrasound, CT and MRI were 90.8% （109/120）, 93. 4% （114/122） and 96.3% （103/107） respectively. Eighteen and ten patients were observed to have elevated serum CA19-9 and CEA respectively. One hundred and five patients received conventional open surgery, while 21 patients underwent laparoscopic operations. The operations in- cluded enucleation of tumor （n= 11）, pancreatic segment resection （n= 5）, spleen preserving distal pancreatectomy （n= 30）, distal pancreatectomy （n= 26）, duodenum-preserving pancreatic head resec- tion （n=4）, pylorus-preserving Whipple resection （n= 5）, Whipple procedure （n= 38）, total pancre- atectomy （n = 2） and exploratory laparotomy and biopsy （n= 5）. The perioperative mortality rate was 0.8% （1/126）. Pancreatic fistula （B and C） occurred in 16 patients （12.7%, 16/126）, and postoper- ative hemorrhage （B and C） occurred in 9 patients （7.1%, 9/126）. One hundred and fourteen pa- tients were followed up from 6 to 72 months （median 52.4 months）. The five-year survival rates for all the pancreatic cystic neoplasms, non-invasive and invasive neoplasms were 80.5%, 96.4% and 40.7% respectively. Conclusions Pancreatic cystic neoplasms are a rare subset of pancreatic tumor, being increasingly detected due to the widespread use of abdominal imaging and improved imaging techniques. Most of them are benign, but some are malignant or they have malignant transformation and metastatic potential. Patients with asymptomatic benign pancreatic cystic neoplasms, especially small size, are candidates for obs

关 键 词：胰腺肿瘤 外科手术 

分 类 号：R735.9[医药卫生—肿瘤]