胰腺浆液性囊腺瘤手术切除患者172例的临床及影像学特征分析  

Clinical and radiological characteristics analysis of 172 cases with resected pancreatic serous cystic neoplasm

作　　者：王端 吴东 戴梦华[2] 朱亮[3] Wang Duan;Wu Dong;Dai Menghua;Zhu Liang(Department of Gastroenterology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;Department of General Surgery,Peking Union Medical College Hospital,Beijing 100730,China;Department of Imaging,Peking Union Medical College Hospital,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院、北京协和医院消化内科,北京100730 [2]北京协和医院基本外科,北京100730 [3]北京协和医院放射科,北京100730

出　　处：《中华胰腺病杂志》2024年第1期33-38,共6页Chinese Journal of Pancreatology

基　　金：国家自然科学基金面上项目(82371950)。

摘　　要：目的分析胰腺浆液性囊腺瘤(SCN)手术切除患者的临床与影像学特征。方法回顾性分析2014年9月至2022年4月间北京协和医院172例行手术切除并经病理学诊断为胰腺浆液性囊腺瘤患者的临床和影像学资料,按手术时间将SCN患者分为2014—2018年间(84例)与2019—2022年间(88例)两个时间段进行对比分析。结果SCN的影像学诊断准确率较低,仅占11.6%(20/172),最常误诊为黏液性囊性肿瘤(86/172,50.0%)和导管内乳头状黏液瘤(35/172,20.3%)。2014—2018年间与2019—2022年间两个时间段患者的误诊率差异无统计学意义。与2014—2018年间患者相比,2019—2022年间患者病变位于胰体尾部的占比显著升高(76.1%比53.6%,P=0.004),而位于胰腺头颈部的占比显著下降(22.7%比39.3%,P=0.019);SCN的钙化及病灶周围静脉改变的占比显著下降(22.8%比45.1%,P=0.006;25.0%比46.4%,P=0.003),同时SCN内纤维瘢痕减少(31.8%比45.2%,P=0.070),而上游主胰管扩张病例增加(28.2%比16.3%,P=0.065)。两个时间段患者的临床特征和手术并发症发生率差异均无统计学意义。胰十二指肠切除术后并发症发生率显著高于胰体尾切除术(46.4%比22.9%,P=0.010)。患者出现临床症状与SCN大小和主胰管扩张显著相关(45.4%比29.3%,P=0.032;64.9%比31.2%,P<0.001)。结论SCN术前影像学诊断的准确率始终较低,且近年来不典型影像学特征的SCN占比增加。胰腺切除术后并发症发生率较高,近年未见明显下降趋势。Objective To analyze the clinical and radiological features of patients with resected pancreatic serous cystic neoplasm(SCN).Methods A retrospective analysis was conducted on the clinical and radiological data of 172 patients with pancreatic SCN who underwent surgical resection and were pathological confirmed at Peking Union Medical College Hospital from September 2014 to April 2022.These patients were categorized into two cohorts including 2014—2018 cohort(n=84)and 2019—2022(n=88)for comparative analysis based on the operation time.Results The radiological diagnostic accuracy for SCN was found to be notably low at 11.6%(20/172),which was mostly misdiagnosed as mucinous cystic neoplasms(86/172,50.0%)and intraductal papillary mucinous neoplasms(35/172,20.3%).No statistically significant variance was observed on the misdiagnosis rate between the two cohorts.There was a substantial increase of the number of lesions located in pancreatic body and tail(76.1%vs 53.6%,P=0.004)and a marked decrease in the number of those located in pancreatic head and neck(22.7%vs 39.3%,P=0.019)in 2019-2022 cohort,compared to the 2014-2018 cohort.Furthermore,there was a significant reduction in the occurrence of SCN calcification and peri-lesional venous alterations(22.8%vs 45.1%,P=0.006;25.0%vs 46.4%,P=0.003),a decrease in the presence of fibrous scarring within SCN(31.8%vs 45.2%,P=0.070),and an increase in cases with dilatation of the upstream main pancreatic duct(28.2%vs 16.3%,P=0.065).The clinical characteristics and the rate of postoperative complications did not significantly differ between the two cohorts.Complication rates after pancreatoduodenectomy were significantly higher than those following distal pancreatectomy(46.4%vs 22.9%,P=0.010).The presence of clinical symptoms was significantly linked to the size of SCN and the expansion of the main pancreatic duct(45.4%vs 29.3%,P=0.032;64.9%vs 31.2%,P<0.001).Conclusions The accuracy of preoperative radiological diagnosis for SCN is still low,with a noted increase in the proport

关 键 词：胰腺浆液性囊腺瘤 外科手术 影像学特征 临床特征 术前诊断 

分 类 号：R735.9[医药卫生—肿瘤]