胰腺实性-假乳头瘤51例外科诊治分析  

Surgical treatment of patients with solid-pseudopapillary neoplasm of pancreas:a single center experience in 51 cases

作　　者：李森[1,2] 朱中飞[1] 马洪运[1] 宋博[1] 宋彬[1] 李刚[1] 

机构地区：[1]第二军医大学长海医院胰腺外科,上海200433 [2]河北北方学院第一附属医院普外科,张家口075000

出　　处：《第二军医大学学报》2016年第11期1366-1372,共7页Academic Journal of Second Military Medical University

摘　　要：目的 总结胰腺实性-假乳头瘤（SPNP）临床特点，探讨其诊断及外科治疗方法。方法 收集2008年9月至2012年6月第二军医大学长海医院胰腺外科收治的51例SPNP患者的病例资料，回顾性分析SPNP的临床病理特点及术式选择。根据肿瘤质地将患者分为实性组与囊实性组行病例-对照研究，分析肿瘤质地与侵袭性病理学表现的相关性。结果 51例患者中，45例为女性、6例为男性（7.5：1）；平均发病年龄为33.5±10.8（8-53）岁。临床表现以体检发现肿瘤（43.1%，22/51）、腹部疼痛（31.4%，16/51）及饱胀不适（13.7%，7/51）为主，其余包括腹部扪及包块（5.9%，3/51）和恶心呕吐（5.9%，3/51）。肿瘤直径为1-37.8 cm，平均（6.3±5.8）cm；肿瘤位于胰头者12例（23.5%）、胰颈14例（27.5%）、胰体尾25例（49.0%）。所有患者均接受手术治疗，其中胰十二指肠切除术5例，保留幽门胰十二指肠切除术5例，胰腺节段切除术7例，脾＋胰体尾切除术21例，保脾胰体尾切除术7例，肿瘤局部切除术6例。仅1例患者CA19-9水平轻度升高，其余患者肿瘤标记物均在正常范围内。病理检查结果证实15例有侵袭性病理学表现。病例-对照研究结果示实性肿瘤质地与胰腺实质浸润（P〈0.01）、细胞异型性（P〈0.01）及周围神经浸润（P〈0.05）等高度侵袭性病理学表现相关。51例患者中6例失访，余45例随访时间26-74个月，随访期内患者均存活，且无明显复发或转移证据。结论 SPNP是一种少见的低度恶性肿瘤，手术治疗是目前主要的有效治疗方式，且较小术式更为适合，术后预后良好。实性肿瘤质地与胰腺实质浸润、细胞异型性及周围神经浸润等侵袭性病理学表现相关。Objective To summarize the clinicopathologic features of solid-pseudopapillary neoplasm of pancreas （SPNP）, and to explore its diagnosis and surgical strategy. Methods The clinical data of 51 patients with SPNP were collected from Department of Pancreas Surgery, Changhai Hospital between September 2008 and June 2012, and the clinical characteristics and surgical strategy were retrospectively analyzed. The patients were divided into solid tumor and cystic tumor group according to tumor texture, and a case-control study was designed to analyze the correlation between tumor texture and invasive pathological characteristics. Results Forty-five of the 51 patients were females and 6 were males （7.5：1）, with a mean age of （33.5±10.8） years old at diagnosis, ranging from 8 to 53 years. Twenty-two （43.1%） cases with no symptom were detected by physical examination, 23 cases were detected by epigastric pain （16, 31.4%） or discomfort （7, 13.7%）, 3 （5.9%） patients had a palpable abdominal mass and another 3 （5.9%） had nausea and vomiting. The average diameter of the neoplasms was （6.3±5.8） cm （ranged from 1 to 37.8 cm）. The neoplasms were mainly located at the body and tail of the pancreas （25, 49.0%）, followed by the neck （14, 27.5%） and head （12, 23.5%） of the pancreas. The patients underwent surgical resection via pancreaticoduodenectomy （n=5）, pylorus-preserving pancreaticoduodenectomy （n=5）, segmental pancreatectomy （n=7）, distal pancreatectomy （n=21）, spleen-preserving distal pancreatectomy （n=7） and local resection of pancreatic neoplasms （n=6）. Only one patient had tumor marker （CA19-9） elevated slightly, and others had normal level （CA19-9, CEA, CA125）. Pathologic results showed that 15 of the 51 patients had invasive pathological characteristics. The results of case-control study indicated that solid tumor was significantly correlated with pancreas parenchymal invasion （P〈0.01）, cellular pleomorphism （P〈0.01） and per

关 键 词：胰腺肿瘤 实性-假乳头瘤 肿瘤侵袭 胰腺切除术 

分 类 号：R735.9[医药卫生—肿瘤]