局部切除治疗胰腺良性及低度恶性肿瘤的体会(附45例患者临床资料分析)  

Experience of local pancreatectomy in treatment of benign and low-grade malignantpancreatic tumors (clinical data analysis of 45 cases)

作　　者：周伟[1] 吴河水[1] ZHOU Wei;WU Heshui(Department of Pancreatic Cancer,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430010,P.R.China)

机构地区：[1]华中科技大学同济医学院附属协和医院胰腺外科,武汉430010

出　　处：《中国普外基础与临床杂志》2021年第1期8-11,共4页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨局部切除治疗胰腺良性及低度恶性肿瘤的疗效及可行性。方法回顾性分析华中科技大学同济医学院附属协和医院胰腺外科2014年1月至2019年6月期间收治的45例行局部切除术的胰腺良性及低度恶性肿瘤患者的临床病理资料。结果45例患者均行局部剜除术或切除术,切缘均为阴性。病理结果:实性假乳头瘤17例,黏液性囊腺瘤5例,浆液性囊腺瘤4例,胰岛细胞瘤10例,无功能性神经内分泌肿瘤5例,先天性囊肿4例。肿瘤部位:胰头部6例、胰体部26例、胰尾部8例、钩突部5例。肿瘤直径1.2~9.0 cm,平均3.2 cm,其中超过5.0 cm者有9例。术后虽发生胰瘘26例(57.8%),其中有17例(65.4%)是A级瘘,B级瘘9例(34.6%);腹腔感染6例(13.3%);腹腔出血3例(6.7%);无继发性糖尿病及胰腺内外分泌功能障碍,无围术期死亡病例。患者平均住院时间16.5 d。结论胰腺良性及低度恶性肿瘤经过术前严格评估实施胰腺局部切除术,可有效保留患者胰腺内外分泌功能,尽管胰瘘发生率较高,但多为A级瘘,严重并发症发生率较低。Objective To investigate the role of local pancreatectomy for benign and low-grade malignant pancreatic tumors.Method The clinical data of 45 patients with benign and low-grade malignant pancreatic tumors who underwent local pancreatectomy from January 2014 to June 2019 in Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology were analyzed.Results Forty-five patients underwent the local enucleation or resection with negative margin.The pathological results showed that there were 17 cases of solid pseudopapilloma,5 cases of mucinous cystadenoma,4 cases of serous cystadenoma,10 cases of islet cell tumor,5 cases of nonfunctional neuroendocrine tumor,4 cases of congenital cyst.There were 6 cases of head of pancreas,26 cases of body of pancreas,8 cases of tail of pancreas,5 cases of uncinate process.The tumor was 1.2 to 9.0 cm in diameter with an average of 3.2 cm.Among them,the diameter was more than 5.0 cm in 9 cases.The incidence of pancreatic fistula after operation was 57.8%,65.4%was grade A fistula,34.6%was grade B fistula,and no grade C fistula occurred.The incidence of abdominal infection was 13.3%,incidence of abdominal hemorrhage was 6.7%.There was no secondary diabetes mellitus and pancreatic endo-and exocrine dysfunction,and no death case.Conclusions Pancreatic enucleation for benign and low-grade malignant pancreatic tumors after strict preoperative evaluation can effectively preserve the pancreatic endocrine function of patients.Although the incidence of pancreatic fistula is high,it is mostly biochemical fistula,and the incidence of serious complications is low.

关 键 词：胰腺良性肿瘤 低度胰腺恶性肿瘤 局部切除术 胰瘘 预后 

分 类 号：R735.9[医药卫生—肿瘤]