胰腺腺泡细胞癌14例诊治分析  

Diagnosis and treatment of pancreatic acinar cell carcinoma: an analysis of 14 cases

作　　者：孙永亮[1] 苏治国 杨志英[1] 谭海东[1] 司爽[1] 刘立国[1] 黄笳 SUN Yongliang1, SU Zhiguo2, YANG Zhiying1, TAN Haidong1, SI Shuang1, LIU Liguo1, HUANG Jia1(1. Department of General Surgery, China-Japan Friendship Hospital, Beijing 100029, China; 2. Ninth Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100144, China)

机构地区：[1]国家卫生健康委员会中日友好医院普通外科,北京100029 [2]中国医学科学院北京协和医学院整形外科医院整形九科,北京100144

出　　处：《中国普通外科杂志》2018年第9期1077-1082,共6页China Journal of General Surgery

摘　　要：目的:探讨胰腺腺泡细胞癌临床特征及其诊治与预后。方法:回顾性分析中日友好医院普通外科1997年1月—2017年1月收治的14例胰腺腺泡细胞癌患者的临床资料。结果:14例患者中,男10例,女4例;平均年龄(51.6±15.6岁);初发症状为腹痛7例,黄疸3例,恶心呕吐1例,腹部包块1例,无症状体检发现者2例。患者肿瘤平均直径(9.4±5.2)cm;肿瘤位于胰体尾部10例(64%),胰头部3例,钩突部1例。术前穿刺病理或术中冷冻病理均未能准确诊断胰腺腺泡细胞癌。9例获R0切除,5例因肝转移或局部侵犯周围脏器仅行行胰腺活检或姑息切除及术后化疗。所有患者均经术后病理证实为胰腺腺泡细胞癌。免疫组化显示α-抗胰蛋白酶、α-抗糜蛋白酶、细胞角蛋白(AEl/AE3)阳性率100%。获得R0切除的9利患者,平均生存时间(32.0±25.6)个月;而未获得R0切除的5名患者平均生存时间仅为(4.0±0.8)个月。结论:对于可行R0切除的胰腺腺泡细胞癌,即使伴有肝转移,也应采取积极的手术治疗,术后辅助化疗对预后极其重要。Objective： To investigate the clinical pathological features, and diagnosis and treatment as well as prognosis of pancreatic acinar cell carcinoma. Methods： The clinical data of 14 patients with pancreatic acinar cell carcinoma treated in the Department of General Surgery of China-Japan Friendship Hospital from January 1997 to January 2017 were retrospectively analyzed. Results： Of the 14 patients, 10 cases were males and 4 cases were females, with an average age of （51.6±15.6） years; the initial symptoms included abdominal pain in 7 cases, jaundice in 3 cases, nausea and vomiting in 1 case, and abdominal mass in 1 case, while 2 cases were asymptomatic and discovered by health examination. The average tumor diameter was （9.4±5.2） cm. The tumor was located in the body and tail of the pancreas in 10 cases （64%）, in the head of the pancreas in 3 cases and the uncinate process in 1 case. All preoperative puncture biopsies and intraoperative frozen sections failed to identify pancreatic acinar cell carcinoma. R0 resection was achieved in 9 patients, and 5 patients received only pancreas biopsy or palliative resection due to liver metastasis or adjacent organ invasion. All patients were diagnosed as pancreatic acinar cell carcinoma by postoperative pathological findings. The results of immunohistochemical staining showed that positive expression rates of a-antitrypsin, α-antichymotrypsin and cytokeratin （AE I/AE3） were 100%. The mean survival time of the 9 patients with R0 resection was （32.0±25.6） months, while that of 5 patients without R0 resection was only （4.0±0.8） months. Conclusion： For pancreatic acinar cell carcinoma with a likelihood of R0 resection, aggressive surgical resection should be performed, even in the presence of liver metastases. Postoperative adjuvant chemotherapy is associated with better prognosis.

关 键 词：胰腺肿瘤/诊断 胰腺肿瘤/治疗 癌 腺泡细胞 预后 

分 类 号：R735.9[医药卫生—肿瘤]