胰腺囊性病变的诊治—单中心病例回顾  

Diagnosis and treatment of pancreatic cystic lesions:experience of single center

作　　者：李骥[1] 王晓乙[1] 李恒超[1] 狄扬[1] 蒋永剑[1] 杨峰[1] 姚冽[1] 郝思介[1] 金忱[1] 傅德良[1] 

机构地区：[1]复旦大学附属华山医院,上海200040

出　　处：《上海医药》2014年第10期7-11,共5页Shanghai Medical & Pharmaceutical Journal

基　　金：上海市科委重点科技攻关计划"创新行动计划"(08411954300)

摘　　要：目的 :分享胰腺囊性病变的外科诊治经验,探讨胰腺囊性肿瘤的外科诊治特点。方法 :2002至2012年收治161例胰腺囊性疾病患者,行胰腺囊性肿瘤手术治疗。分析手术方式的选择及相应并发症的发生,结合病理分类的变革和差异讨论胰腺囊性肿瘤在外科诊治决策上的趋势。结果 :161例中,胰腺囊性病变位于胰头/钩突部74例,颈体尾部87例;行胰十二指肠切除术59例,胰体尾切除术50例,胰腺中段切除术6例,全/残胰切除术4例,胰腺肿瘤局部剜除术18例和囊肿内/外引流术24例。手术标本经病理证实为胰腺假性囊肿、先天性囊肿、浆液性囊腺瘤(癌)、黏液性囊腺瘤(癌)、导管内乳头状黏液样瘤(癌)和实性假乳头状瘤(癌)。无围手术期死亡病例发生,术后胰瘘的总发生率为44.7%(A级19.2%、B级25.5%)。结论 :应充分重视胰腺囊性病变,尤其是胰腺囊性肿瘤。对于胰腺囊性肿瘤中胰腺导管内乳头状黏液样瘤的诊治已是临床研究热点,而其与胰腺黏液性囊腺瘤的鉴别诊断值得进一步深入讨论。Objective：To share the experience and explore the strategies of the diagnosis and treatment for pancreatic cystic lesions. Methods：One hundred and sixty one patients with cystic diseases of the pancreas were enrolled and received pancreatic cystic tumor surgery between 2002 and 2012. The choice of operation method and its complications were analyzed. The surgical decisions and trends on treatment of pancreatic cystic diseases were discussed with their pathological change and difference of classiifcation . Results：Of 161 patients with pancreatic cystic lesions, the lesions located in the head or uncinate were found in 74 patients, and in the body and tail in 87 patients. The pancreaticoduodenectomy performed on 59 patients, distal pancreatectomy on 50 patients, middle pancreatectomy on 6 patients , full/residual pancreatectomy on 4 patients , enucleation on 18 patients and internal or external drainage on 24 patients . Final pathological diagnosis was pancreatic pseudocysts, congenital cysts, serous cystadenoma （carcinoma）, mucinous cystadenoma （cancer）, intraductal papillary mucinous neoplasm （cancer） and solid pseudopapillary tumor （cancer）. No perioperative deaths occurred, and the overall incidence of postoperative pancreatic fistula was 44.7% （grade A in 19.2%, grade B in 25.5%）. Conclusion： Pancreatic cystic lesions, especially pancreatic cystic tumors, should be received adequate attention. Since the diagnosis and treatment of intraductal papillary mucinous neoplasm become the focus in the clinical research for pancreatic cystic tumors, its differential diagnosis of mucinous cystic neoplasm should be worth further discussion.

关 键 词：胰腺囊性肿瘤 胰管内乳头状黏液样瘤 黏液性囊腺瘤 浆液性囊腺瘤胰腺假性囊肿 

分 类 号：R735.9[医药卫生—肿瘤]