胰腺浆液性囊腺瘤104例临床诊治分析  

Diagnosis and treatment of pancreatic serous cystic neoplasms:a report of 104 cases

作　　者：朱中飞 毛宽政 张佳琛 宋彬 ZHU Zhongfei;MAO Kuanzheng;ZHANG Jiachen;SONG Bin(Department of Hepatobiliary and Pancreatic Surgery,the First Affiliated Hospital of Naval Military Medical University,Shanghai 200433,China;School of Health Science and Engineering,University of Shanghai for Science and Technology,Shanghai 200093,China)

机构地区：[1]中国人民解放军海军军医大学第一附属医院肝胆胰外科,上海200433 [2]上海理工大学健康科学与工程学院,上海200093

出　　处：《中国普通外科杂志》2024年第3期357-365,共9页China Journal of General Surgery

基　　金：国家自然科学基金资助项目(82073307);2022年中国人民解放军海军军医大学校级基础医学研究课题面上孵化基金资助项目(2022MS026)。

摘　　要：背景与目的:胰腺浆液性囊腺瘤(SCN)属于良性疾病,恶变率极低,但该病术前鉴别诊断困难,多需手术切除以排除恶性病变。提高胰腺SCN术前诊断准确性可减少不必要手术,从而规避手术风险与并发症。因此,本研究通过对已行手术切除的胰腺SCN患者的资料分析,探讨胰腺SCN准确诊断的影响因素。方法:回顾性收集2018年6月—2020年12月间中国人民解放军海军军医大学第一附属医院肝胆胰外科行手术切除并经病理证实为胰腺囊性肿瘤的231例患者的临床资料,其中,104例(45.02%)为SCN,127例(54.98%)为非SCN。比较SCN患者与非SCN患者的手术与术后并发症情况;分析SCN患者术前影像学检查价值及干扰术前正确诊断的相关因素。结果:104例SCN患者中,62例(59.62%)在健康体检中发现;77例(74.04%)肿瘤位于胰体尾;术后出现生化漏55例、B级胰瘘3例、A/B级胃排空障碍8例、C级胃排空障碍3例、术后出血1例。127例非SCN患者中,83例(65.35%)在健康体检中发现;103例(81.10%)肿瘤位于胰体尾;术后出现生化漏51例,B级胰瘘1例;A/B级胃排空障碍11例、C级胃排空障碍3例、术后出血1例。SCN患者与非SCN患者的手术方式、术后严重并发症(胰瘘、胃排空障碍及出血)发生率差异均无统计学意义(均P>0.05)。104例SCN患者术前正确诊断率为32.69%(34例),上腹部CT增强正确诊断19例,胰腺MR增强正确诊断15例,其中12例有囊壁强化、19例囊内存在分隔、5例囊内钙化、6例伴有实性成分及3例主胰管扩张。单因素分析提示,辅助检查类型(P=0.012)、囊壁是否强化(P=0.065)、囊内是否有分隔(P=0.002)、囊内是否钙化(P=0.077)、囊内有无实性成分(P=0.019)及主胰管是否扩张(P=0.094)与SCN正确诊断与否有关;多因素分析结果提示,MRI检查(OR=3.619,95%CI=1.274~10.729,P=0.016)与囊内分隔(OR=3.610,95%CI=1.289~10.107,P=0.015)是SCN正确诊断独立影响因素,囊内实性成分(OR=0.334,95%CIBackground and Aims:Pancreatic serous cystic neoplasms(SCN) are benign diseases with an extremely low rate of malignant transformation.However,preoperative differentiation diagnosis of them is difficult,often requiring surgical resection to exclude malignant lesions.Improving the accuracy of preoperative diagnosis of pancreatic SCN can reduce unnecessary surgeries,thus mitigating surgical risks and complications.Therefore,this study was conducted to investigate the factors influencing the accurate diagnosis of pancreatic SCN through data analysis of pancreatic SCN patients who had undergone surgical resection.Methods:The clinical data of 231 patients who underwent surgical resection for pancreatic cystic neoplasms and were pathologically confirmed between June 2018 and December 2020 in the Department of Hepatobiliary and Pancreatic Surgery of the First Affiliated Hospital of Naval Medical University were retrospectively collected.Among them,104 cases(45.02%) were SCN,and 127 cases(54.98%) were non-SCN.Surgical procedures and postoperative complications of SCN and non-SCN patients were compared.The value of preoperative imaging examinations in SCN patients and factors interfering with preoperative correct diagnosis were analyzed.Results:Among the 104 SCN patients,62 cases(59.62%) were incidentally found during health maintenance examination,and 77 cases(74.04%) had tumors located in the body or tail of the pancreas.After operation,biochemical leak occurred in 55 cases,grade B pancreatic fistula occurred in 3 cases,grade A/B gastric emptying disorder occurred in 8 cases,grade C gastric emptying disorder occurred in 3 cases,and postoperative bleeding occurred in 1 case.Among the 127 non-SCN patients,83 cases(65.35%) were incidentally found during health maintenance examination,and 103 cases(81.10%) had tumors located in the body or tail of the pancreas.After operation,biochemical leak occurred in 51 cases,grade B pancreatic fistula occurred in 1 case,grade A/B gastric emptying disorder occurred in 11 cases,grade C g

关 键 词：胰腺肿瘤 肿瘤 囊性 黏液性和浆液性 诊断显像 

分 类 号：R735.9[医药卫生—肿瘤]