胰腺囊性肿瘤临床诊治特征分析：附112 例报告
| 作者: |
1王克,
2单云峰
1 温州医科大学附属乐清医院 外一科，浙江 乐清 325600 2 温州医科大学附属第一医院 肝胆外科，浙江 温州 325000 |
| 通讯: |
单云峰
Email: shanyf@yahoo.com |
| DOI: | 10.3978/.10.3978/j.issn.1005-6947.2015.03.018 |
摘要
目的：探讨胰腺囊性肿瘤临床特点、诊断方式以及治疗结局，为临床诊治提供参考。 方法：回顾性分析2007 年9 月—2014 年9 月112 例胰腺囊性肿瘤患者的临床资料。 结果：112 例患者中，111 例（99.1%）胰腺囊性肿瘤单发；确诊时81 例（72.32%）患者无明显临床 症状；超声、CT、MRI、EUS 诊断的准确率分别为86.61%、89.11%、93.88%、93.33%，4 种检查方 式准确率差异无统计学意义（χ2=1.010，P=0.224）；胰体尾加脾切除术48 例（42.86%），胰十二 指肠切除术23 例（20.54%），保留脾脏胰体尾切除13 例（11.61%），Beger 术3 例（2.68%），全 胰腺切除2 例（1.78%）， 胰腺中段切除1 例（0.89%）， 联合脏器切除1 例（0.89%）， 肿瘤摘除 21 例（18.75%）；术后发生胰瘘18 例（16.07%），其中胰十二指肠切除术后胰瘘发生7 例（30.43%， 7/23），胰体尾加脾切除胰瘘发生9 例（18.75%，9/48），保留脾脏胰体尾切除术后胰瘘发生2 例（15.38%， 2/13），胰十二指肠切除术后胰瘘发生率明显高于其他两种术式（χ2=4.767，P=0.010；χ2=5.854， P=0.007）；76 例（67.86%）病理结果良性，36 例（32.14%）病理结果恶性。良性患者5 年生存率为 100%，恶性患者1、3、5 年生存率分别为86.96%、52.17%、26.08%。 结论：胰腺囊性肿瘤多数患者无明显临床症状，单发胰体尾部胰腺肿瘤占多数，影像学诊断准确率较高， 良性胰腺囊性肿瘤预后好，恶性胰腺囊性肿瘤应积极实施根治手术。
关键词：
胰腺肿瘤/ 诊断
胰腺肿瘤/ 治疗
胰腺囊肿
Clinical diagnosis and treatment characteristics of pancreatic cystic neoplasms: a report of 112 cases
CorrespondingAuthor:SHAN Yunfeng Email: shanyf@yahoo.com
Abstract
Objective: To investigate the clinical features, diagnostic methods and treatment results of pancreatic cystic neoplasms, so as to provide reference for use in clinical practice. Methods: The clinical data of 112 patients with pancreatic cystic neoplasms admitted from September 2007 to September 2014 were retrospectively analyzed. Results: Of the 112 patients, 111 cases (99.1%) were solitary pancreatic cystic tumor; 81 diagnosed cases (72.32%) had no obvious clinical symptoms, and diagnostic accuracy of ultrasound, CT, MRI and EUS was 86.61%, 89.11%, 93.88%, and 93.33% respectively, which showed no significant difference among the 4 methods of examination (χ2=1.010, P=0.224). Distal pancreatectomy plus splenectomy was performed in 48 patients (42.86%), pancreaticoduodenectomy in 23 cases (20.54%), distal pancreatectomy with spleen preservation in 13 cases (11.61%), and Beger procedure in 3 cases (2.68%). Postoperatively, pancreatic fistula occurred in 18 cases (16.07%), of whom 7 cases (30.43%, 7/23) underwent pancreaticoduodenectomy, 9 cases (18.75%, 9/48) had distal pancreatectomy plus splenectomy, and 2 cases (15.38%, 2/13) received spleen-preserving distal pancreatectomy, and the incidence of pancreatic fistula after pancreaticoduodenectomy was significantly higher than that after the other two procedures (χ2=4.767, P=0.010; χ2=5.854, P=0.007). Pathological examination showed that the lesion in 76 cases (67.86%) was benign, and in 36 cases (32.14%) was malignant. The 5-year survival rate in patients with benign tumor was 100%, and the 1-, and 3- and 5-year survival rate in patients with malignant tumor was 86.96%, 52.17% and 26.08%, respectively. Conclusion: The majority of patients with pancreatic cystic neoplasms have no obvious clinical symptoms. In most cases the tumors are solitary and located in the body and tail of the pancreas, and imaging examinations have high diagnostic accuracy. Benign pancreatic cystic neoplasms have a good prognosis, while aggressive radical resection should be performed for the malignant ones.
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