胰腺囊性肿瘤的诊断与治疗  

Diagnosis and treatment of pancreatic cystic neoplasms

作　　者：年建泽[1] 刘付宝[1] 陈江明[1] 朱兴阳[1] 梁超杰[1] 谢坤[1] 黄帆[1] 耿小平[1] 

机构地区：[1]安徽医科大学第一附属医院器官移植及肝胆胰外科二病区,合肥230022

出　　处：《中华消化外科杂志》2015年第8期648-652,共5页Chinese Journal of Digestive Surgery

基　　金：安徽省自然科学基金（130808MH133）

摘　　要：目的探讨胰腺囊性肿瘤的临床特点以及诊断与治疗。方法回顾性分析2010年1月至2014年12月安徽医科大学第一附属医院收治的62例胰腺囊性肿瘤患者的临床资料。良性黏液性囊腺瘤（MCN）、浆液性囊腺瘤（SCN）、良性实性假乳头状瘤（SPN）、导管内乳头状黏液瘤（IPMN）设为良性肿瘤患者，交界性或恶性MCN、交界性或恶性IPMN设为恶性肿瘤患者。分析患者性别、年龄、临床症状、影像学检查结果、实验室检查结果、手术方式、手术时间、术中出血量、围术期并发症、病理学检查结果和随访结果等指标。采用电话及门诊复查相结合的方式随访，随访时间截至2014年12月31日或患者死亡。正态分布的计量资料以元±S表示，非正态分布的计量资料以肼（范围）表示，计数资料采用，检验或Fisher确切概率法进行单因素分析，采用Logistic回归模型进行多因素分析。结果62例患者中，31例因上消化道不适症状等就诊，10例无特异性表现，在健康体检时发现，10例近2～3个月出现体质量明显减轻，9例可触及腹部包块，2例因梗阻性黄疸入院。62例患者影像学检查发现肿瘤直径为（60±35）mm；肿瘤位于头颈部11例，胰体尾部5l例。其中33例患者发现囊内结节或实性成分，6例发现主胰管扩张。患者B超、CT、MRI、超声内镜（EUS）及PET／CT检查的诊断阳性率分别为85．5％（53／62）、93．2％（55／59）、94．1％（16／17）、100．0％（3／3）及100．0％（2／2）。62例患者术前CEA为1．22μg/L（0．20～12．98斗再／L），CA19-9为10．85U／mL（0．60～1000．00U／mL）；CEA升高者仅占4．8％（3／62），CA19-9升高者仅占14．5％（9／62）。62例患者均行手术治疗，其中联合脾脏切除的胰体尾切除术36例，胰十二指肠切除术10例，胰腺部分切除术7例，保留脾脏的胰体尾切除术6例，单纯囊肿切除术2例Objective To investigate the clinical features, diagnosis and treatment of pancreatic cystic neoplasms. Methods The clinical data of 62 patients with pancreatic cystic neoplasms who were admitted to the First Affiliated Hospital of Anhui Medical University from January 2010 to December 2014 were retrospectively analyzed. Benign neoplasms included benign mucinous cystic neoplasm （MCN） , serous cystic neoplasm （SCN） , solid pesudopapillary neoplasm （SPN） and intraductal papillary mueinous neoplasm （IPMN） and malignant neoplasms included borderline or malignant MCN and borderline or malignant IPMN. The sex, age, clinical symp- toms, imaging features, laboratory results, surgical method, operation time, volume of intraoperative blood loss, perioperative complications, result of pathological examination and follow-up were analyzed. Patients were followed up by telephone interview and outpatient examination up to 31, December 2014 or death. Measurement data with normal distribution were presented by x ± s, while measurement data with non-normal distribution were presented by M （range）. Univariate analysis of count data was done by chi-square test or Fisher exact probability. Multivariate analysis was done by Logistic regression model. Results Of the 62 patients with pancreatic cystic neoplasms, 31 were retreated due to upper digestive discomfort, 10 without specific features were found during the health exami- nations, 10 due to weight loss in near 2-3 months, 9 due to abdominal masses and 2 due to obstructive jaundice. Results of radiographic examinations showed that the diameter of the tumor is （60 ± 35 ） mm, 11 of tumors located in the head and neck of pancreas and 51 located in the body and tail of pancreas. The cystic nodule or solid ingre- dients were detected in 33 patients and main pancreatic duct dilation in 6 patients. The positive diagnostic rates of B ultrasound, computed tomography （CT）, magnetic resonance imaging （MRI）, and endoscopic uhrasonography （EUS） and positron

关 键 词：胰腺囊性肿瘤 诊断 治疗 

分 类 号：R735.9[医药卫生—肿瘤]