胰腺实性假乳头状瘤的临床特征及治疗  

Clinical features and treatment of solid pseudopapillary neoplasm of the pancreas

作　　者：展翰翔[1] 程玉刚 韩海峰[1] 苏鹏[2] 钟宁[3] 朱民[1] 张宗利[1] 智绪亭[1] 张光永[1] 王磊[1] 胡三元[1] 

机构地区：[1]山东大学齐鲁医院普通外科,济南250012 [2]山东大学齐鲁医院病理科,济南250012 [3]山东大学齐鲁医院消化内科,济南250012

出　　处：《中华消化外科杂志》2017年第10期1005-1012,共8页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金（81702365）;山东省自然科学基金（ZR2017MH090）

摘　　要：目的探讨胰腺实性假乳头状瘤（SPN）的临床特征与治疗方法。方法采用回顾性横断面研究方法。收集2012年1月至2017年7月山东大学齐鲁医院收治的69例胰腺SPN患者的临床病理资料。患者术前行血清肿瘤标志物、腹部增强CT或MRI检查，部分患者行EUS检查。完善检查后制订手术方案。观察指标：（1）临床特征。（2）治疗情况。（3）病理学检查情况。（4）随访情况。采用门诊和电话方式进行随访，了解患者生存及肿瘤复发、转移情况。随访时间截至2017年7月。正态分布的计量资料以x±s表示，比较采用Student’st检验。计数资料比较采用爿。检验。结果（1）临床特征：①流行病学特征：69例患者中，男女比例为1：5．9；年龄9～65岁，〈30岁40例，≥30岁29例。男性患者发病年龄为（34±15）岁，女性患者为（28±11）岁，两者比较，差异无统计学意义（t=-1．364，P〉0．05）。69例患者中，胰腺SPN位于胰头钩突25例，胰颈12例，胰体尾32例。②病史：69例患者均无急、慢性胰腺炎病史。无腹部外伤病史。③临床表现：69例患者中，26例无明显症状，健康体检时发现；31例有腹上区胀满不适、腹痛、恶心、呕吐等症状；10例因发现腹上区包块就诊；1例因黄疸就诊；1例患者因恶心、排便困难就诊。④实验室检查：69例患者术前血清CEA和CA19-9水平均正常。⑤影像学检查：69例患者均行腹部CT检查，CT平扫示肿瘤为圆形或类圆形低密度影，51例囊实性，13例单纯实性，5例单纯囊性；64例肿瘤有完整包膜，5例与胰腺实质邻近脏器界限模糊；14例实性部分或者包膜可见钙化灶。10例患者行腹部MRI检查，MRI平扫示T1加权成像呈等或稍低信号，T2加权成像呈稍高信号，肿瘤包膜T1加权成像和T2加权成像呈现连续或不连续环形低信号带。MRI增强扫描示肿瘤囊壁与实性成分动脉期�Objective To investigate the clinical features and treatment of solid pseudopapillary neoplasm （SPN） of the pancreas. Methods The retrospective cross-sectional study was conducted. The clinicopathological data of 69 patients with SPN of the pancreas who were admitted to the Qilu Hospital of Shandong University from January 2012 to July 2017 were collected. Serum tumor markers detection, enhanced computed tomography （CT） and magnetic resonance imaging （MRI） of abdomen were carried out preoperatively for all the patients, and a part of the patients received endoscopic uhrasonography （EUS）. Surgery plans were formulated after completion of examinations. Observation indicators ： （ 1 ） clinical features ; （2） treatment situation ; （ 3 ） resuhs of pathological examination; （4）follow-up. All the patients were followed up via outpatient examination and telephone interview to detect the survival and tumor recurrence and metastasis till July 2017. Measurement data with normal distribution were presented by x＋s and were compared by Student＇s t test. Count data were compared by chi-square test. Results （1） Clinical features ： （1） epidemiologic features ： the ratio of male to female was 1：5.9 ; patients were aged between 9 and 65 years, including 40 under 30 years and 29 above or equal to 30 years. The onset age was （34±15） years for male patients and （28 ±11）years for female patients, respectively, with no statistically significant difference （t=-1. 364, P〉0. 05）. Of 69 patients, SPN was located at pancreatic uncinate process in 25 patients, at neck of pancreas in 12 patients, body and tail of pancreas in 32 patients. （2） Medical history： history of acute or chronic pancreatitis and abdominal trauma were denied by all the 69 patients. （3） Clinical manifestation： 26 patients had no obvious symptoms and were detected by physical examination; 31 patients had discomfort in upper abdomen, nausea and vomiting; other patients were admitted to the hospit

关 键 词：胰腺实性假乳头状瘤 临床特征 影像学 腹腔镜检查 

分 类 号：R735.9[医药卫生—肿瘤]