18F-FDG PET鉴别肾上腺良恶性肿瘤的临床价值

目的：评价^18F-氟代脱氧葡萄糖正电子发射计算机断层显像(^18F-FDG PET)在肾上腺病变定性诊断中的应用价值。方法：回顾性分析22例28个肾上腺肿瘤患者的临床资料，均采用^18F-FDG PET显像，以鉴别肾上腺肿瘤为原发性抑或继发性，同期均行CT检查。结果：CT检查28个肿瘤中22个为恶性肿瘤(其中6个经手术或活检证实，16个随访证实)，6个通过活检或随访证实为良性病变。CT发现的19个肾上腺肿瘤中。17个为恶性肿瘤，^18F—FDG PET显像均为阳性。^18F—FDG PET对肾上腺肿瘤的定性判断的灵敏度、特异度和准确度分别为100％、66．7％和92．9％。结论：^18F—FDG PET通过肿瘤的葡萄糖代谢程度来判定病变的性质，对肾上腺恶性病变的标准摄取率(SUV)相对较高，在肾上腺肿瘤良恶性鉴别中可以提供重要的依据。     

镜下少量血尿中尿脱落细胞端粒酶活性的临床意义

目的 探讨尿脱落细胞端粒酶活性(telomerase activity of urinary exfoliated cells,TUEC)检测在镜下少量血尿(microsopic hermaturia,MHU)病人中的诊断和鉴别诊断意义。方法 采用端粒酶TRAP—PCR ELISA及TRAP—银染法对30例MHU病人、30例健康对照及17例尿路上皮肿瘤行TUEC检测，MHU组还检测膀胱镜。结果 慢性膀胶炎中TUEC 16/24阳性，其诊断膀胱炎的灵敏度为66．7％，特异性66．7％。膀胱炎组与肿瘤组中TUEC总体阳性率及定量值均无差异(P＝0．607，P＝0．645)，但两组TUEC阳性值的中位数有差异(P＝0．030)。结论 TUEC检测结果结合病史分析及其他检查，可使部分病人免做膀脱镜检查而初步诊断为慢性膀胱炎，但当TUEC值较高．肿瘤不能排除。     

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目的 探讨胰腺损伤的诊断和治疗方法。方法 回顾性分析1983～2002年收治的65例胰腺损伤的临床资料。结果 胰腺损伤Ⅰ级7例，Ⅱ级24例，Ⅲ级19例，Ⅳ级10例，Ⅴ级5例。单纯胰腺损伤13例(20．0％)，合并其他器官损伤52例(80．0％)。术前诊断为胰腺损伤的仅12例(18．5％)。65例均行手术治疗，治愈56例(86．2％)，死亡9例(13．8％)。结论 胰腺损伤早期诊断困难，应高度警惕。对怀疑或诊断为胰腺损伤者，应尽早手术探查，并根据损伤的部位及严重程度，选择合理的手术方式。     

胰腺及壶腹236例术中针吸活检的临床意义

目的 探讨术中细针活检细胞组织学诊断在胰腺壶腹周围占位性病变的诊断价值。方法 对天津肿瘤医院，自1992年12月-2002年12月经手术治疗236例胰腺壶腹周围占位性病变行术中细针活检，所有病例均经病理证实其符合率。结果 236例中细针活检诊断找到恶性肿瘤细胞134例（56．8％），未找到恶性肿瘤细胞为82例（34．7％），6例（2．5％）为可疑，14例（5．9％）为取材不满意。无假阳性诊断，假阴性为9．4％。结论 胰腺壶腹周围占位性病变术中细针活检细胞学检查，对明确良恶性肿瘤诊断、指导术式选择是一种较实用，有效的方法。     

CEA RT-PCR检测胃癌腹腔灌洗液游离癌细胞临床价值的初步观察

目的：初步观察癌胚抗原(CEA)逆转录．聚合酶链反应(RT-PCR)检测胃癌腹腔洗液中游离癌细胞的临床价值。方法：收集36例进展期胃癌和6例慢性胆囊结石病人腹腔灌洗液100ml，其中50ml行CEA RT-PCR，扩增CEA特异性片断；50ml行细胞学检查。胃癌细胞株MKN-45为阳性对照。结果：36例胃癌病人腹腔灌洗液中14例于131 bp处见CEA的特异性条带，阳性率为38．9％(14／36)；6例慢性胆囊结石病人腹腔灌洗液RT-PCR结果均为阴性；MKN-45在131bp处发现CEA的特异性条带。细胞病理学检查，36例胃癌病人中有6例腹腔灌洗液中发现有肿瘤细胞或核异形细胞，阳性率为16．6％(6／36)，且此6例RT-PCR结果均为阳性；8例RT-PCR结果阳性病人的细胞学检查为阴性。CEA RT-PCR的阳性率与肿瘤胃壁浸润深度、淋巴结转移数和胃癌分化程度明显相关。随访至今，36例进展期胃癌病人中CEA RT-PCR检查阴性的病人尚无一例腹腔内肿瘤复发，1例细胞学检查阴性而CEA RT-PCR阳性的病人术后4个月时出现腹腔内肿瘤复发。结论：腹腔灌洗液中胃癌细胞CEA mRNA的RT-PCR检测法敏感性较高．初步临床观察及随访显示该法有望作为诊断腹腔内游离癌细胞的有效辅助手段。     

胰腺损伤24例临床诊治分析

目的：总结胰腺损伤的诊治经验。方法：回顾性分析我院近10年胰腺损伤病人临床资料。结果：Ⅰ级损伤7例，Ⅱ级损伤5例，Ⅲ级损伤6例，Ⅵ级损伤4例，Ⅴ级损伤2例。术前确诊14(58，3％)，所有病例均行手术治疗，治愈20(83．3％)，死亡4例(16，7％)，发生并发症10例(41．7％)。结论：胰腺损伤早期诊断困难，腹腔穿刺液淀粉酶及CT检查有助于提示胰腺损伤，手术探查要全面，个体化手术处理胰腺损伤有助于减少并发症，提高治愈率。     

腹腔镜在胰腺肿瘤诊断和分期中的价值

目的:总结胰腺肿瘤剖腹手术前先行腹腔镜探查的价值。方法:对12例经B超和CT诊断或怀疑为胰腺肿瘤的病人,在剖腹手术前先行腹腔镜探查,其中2例联合使用腹腔镜超声检查(LUS)。结果:1例CT诊断疑为胰头肿瘤伴少量腹水者,腹腔镜明确为原发性腹膜炎,作冲洗引流而愈。2例影像学检查见胰体尾增厚,怀疑胰腺肿瘤者,腹腔镜检查未见明显异常,再作LUS检查,1例为胰腺囊肿,另1例未见异常。9例腹腔镜检查确诊为胰腺恶性肿瘤病人中,3例明确已有远处转移,从而避免了开腹;另6例腹腔镜探查提示可以切除,结果其中1例由于肠系膜血管被肿瘤包绕而无法切除,余5例(5/9=55.6%)进行了根治性切除。腹腔镜探查在评估胰腺癌不可切除性的敏感性为75%,特异性为100%,阳性预测值为100%,阴性预测值为83.3%。结论:腹腔镜探查可发现影像学检查不能发现的腹膜转移,结合腹腔镜超声检查可提高胰腺肿瘤诊断、分期的准确性,使部分病人避免了不必要的剖腹手术。     

结(直)肠肿瘤病人行 18F-FDG PET显像检查的护理

应用^18F-脱氧葡萄糖(^18F-FDG)正电子发射型计算机断层(PET)显像对76例结(直)肠肿瘤病人行定性诊断，其灵敏度为92．9％，特异性为90．0％。护理包括检查前控制血糖于正常范围，口服普鲁苯辛减少肠道生理性摄取；注射药物时，防止^18F-FDG渗出静脉；注射药物后，饮水及膀胱冲洗、导尿降低或减少药物在泌尿系的浓聚；检查时行逆行扫描并防止病人身体移动；检查后嘱病人饮水排泄放射性药物。     

胰腺神经内分泌肿瘤影像研究现状及进展

目的总结胰腺神经内分泌肿瘤影像学研究现状及进展。方法对近年来胰腺神经内分泌肿瘤影像学的相关文献进行综述。结果由于胰体和胰尾的可视性欠佳,超声(US)的应用受限,相较于US,内窥镜超声检查(EUS)和超声造影(CEUS)可提高肿瘤的检出率。CT平扫对病理分级的鉴别能力尚有争议,但增强扫描的鉴别价值较高,CT图像纹理鉴别乏血供胰腺神经内分泌肿瘤和胰腺导管腺癌是可行的,其中纹理特征Teta2具有较高的诊断效能。MRI的增强特征与CT类似;联合表观弥散系数(ADC)值,MRI的诊断及分级能力提高,并且不同ADC阈值的灵敏度和特异度也有所差异。⁶⁸Ga-四氮杂环十二烷四乙酸(⁶⁸Ga-DOTA)肽PET-CT对分化较好的胰腺神经内分泌肿瘤具有很好的初步诊断价值,但氟代葡萄糖-正电子计算机断层扫描(¹⁸F-FDG PET-CT)的诊断价值有限。结论目前生长抑素受体成像对胰腺神经内分泌肿瘤的诊断价值较高,并可指导临床治疗和预测预后,但我国尚未普及。常规形态学影像对胰腺神经内分泌肿瘤的诊断及分级各有优势。因此,合理选择影像检查方法至关重要。     

CK19表达及其在结肠癌淋巴结微转移诊断中的应用

目的：研究用免疫组化方法检测CK19及其在结肠癌淋巴结微转移诊断中的应用与临床病理意义。方法：取材于50例结肠癌病人肿瘤组织及癌周淋巴结255枚，同时进行HE染色组织学检查和抗角蛋白19抗体的免疫组化检测。结果：50例结肠癌组织中CK19表达均为阳性。255枚淋巴结用HE染色检查阳性者56枚(22．0％)，皆同时表达CK19阳性；另20枚淋巴结HE染色阴性，而CK19表达阳性。50例中有12例淋巴结中发现微转移，其中6例常规组织学检查属淋巴结转移阴性而免疫组化染色诊断表现为转移阳性。占常规病理检查淋巴结转移阴性者的21．4％(6／28)。随着肿瘤分期增加,淋巴结CK19表达阳性率亦增加。CK19表达阳性者预后较阴性者为差。结论：CK19免疫组化法是检测结肠癌淋巴结微转移的敏感而便捷的方法，而检测结肠癌微转移有助于判断肿瘤进展程度与预后。特别对在筛选组织学检查淋巴结阴性但存在微转移的病人有实用价值。     

Value of 18-Fluorodeoxyglucose Positron Emission Tomography in the Management of Patients With Cystic Tumors of the Pancreas

OBJECTIVE: To assess the reliability of 18-fluorodeoxyglucose positron emission tomography (18-FDG PET) in distinguishing benign from malignant cystic lesions of the pancreas. SUMMARY BACKGROUND DATA: The preoperative differential diagnosis of cystic lesions of the pancreas remains difficult: the most important point is to identify malignant or premalignant cysts that require resection. 18-FDG PET is a new imaging procedure based on the increased glucose metabolism by tumor cells and has been proposed for the diagnosis and staging of pancreatic cancer. METHODS: During a 4-year period, 56 patients with a suspected cystic tumor of the pancreas underwent 18-FDG PET in addition to computed tomography scanning, serum CA 19-9 assay, and in some instances magnetic resonance imaging or endoscopic retrograde cholangiopancreatography. The 18-FDG PET was analyzed visually and semiquantitatively using the standard uptake value. The accuracy of 18-FDG PET and computed tomography was determined for preoperative diagnosis of a malignant cyst. RESULTS: Seventeen patients had malignant tumors. Sixteen patients (94%) showed 18-FDG uptake with a standard uptake value of 2.6 to 12.0. Twelve patients (70%) were correctly identified as having malignancy by computed tomography, CA 19-9 assay, or both. Thirty-nine patients had benign tumors: only one mucinous cystadenoma showed increased 18-FDG uptake (standard uptake value 2.6). Five patients with benign cysts showed computed tomography findings of malignancy. Sensitivity, specificity, and positive and negative predictive values for 18-FDG PET and computed tomography scanning in detecting malignant tumors were 94%, 97%, 94%, and 97% and 65%, 87%, 69%, and 85%, respectively. CONCLUSIONS: 18-FDG PET is more accurate than computed tomography in identifying malignant pancreatic cystic lesions and should be used, in combination with computed tomography and tumor markers assay, in the preoperative evaluation of patients with pancreatic cystic lesions. A positive result on 18-FDG PET strongly suggests malignancy and, therefore, a need for resection; a negative result shows a benign tumor that may be treated with limited resection or, in selected high-risk patients, with biopsy, follow-up, or both.     

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??Clinical value of serum CA19-9 in the diagnosis of suspected pancreatic cancer by imaging methods WANG Wei-lin*, WU Ze-hui, ZHU Feng, et al. Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou310003, China
Corresponding author: ZHENG Shu-sen, E-mail:shusenzheng@zju.edu.cn
Abstract Objective To explore the clinical value of the combination of serum tumor marker CA19-9 and imaging methods (computed tomography and magnetic resonance imaging) in the diagnosis of pancreatic cancer. Methods The clinical data of 267 patients with suspected pancreatic cancer by imaging methods admitted from January 2010 to February 2012 in Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital of Medical School of Zhejiang University were analyzed retrospectively. Results In all 267 patients, 225 (83.0%) and 42 (17.0%) patients were diagnosed as pancreatic cancer and non-pancreatic cancer respectively. In the pancreatic cancer group, serum CA19-9 was elevated in 173 (76.9%) patients. Eighty-five patients with suspected pancreatic cancer by imaging methods had normal CA19-9 value. Among them, 52 (61.2%) patients were finally diagnosed as pancreatic cancer on pathology, and 33 (38.8%) patients as non-pancreatic cancer. One hundred and eighty-two patients with suspected pancreatic cancer by imaging methods had elevated CA19-9 value. Among them, 173 patients were finally diagnosed as pancreatic cancer on pathology and 9 patients as non-pancreatic cancer. Conclusion Serum tumor marker CA19-9 may provide valuable clues for the diagnosis of pancreatic cancer which is suspected by imaging methods. As to CA19-9 negative patients, in whom pancreatic cancer is suspected by imaging methods, much more attention should be paid to the possibility of false positive results of imaging methods. Pancreas puncture before surgery is recommended to confirm the diagnosis and exclude the possibility of chronic pancreatitis, pancreatic neuroendocrine tumors and solid-pseudopapillary tumor, etc. As to patients with elevated CA19-9 and imaging methods suspected pancreatic cancer, operation is recommended.     

18-fluorodeoxyglucose positron emission tomography enhances computed tomography diagnosis of malignant intraductal papillary mucinous neoplasms of the pancreas

OBJECTIVE: To assess the reliability of 18-fluorodeoxyglucose positron emission tomography (18-FDG PET) in distinguishing benign from malignant intraductal papillary mucinous neoplasms (IPMNs) of the pancreas and its contribution to surgical decision making. SUMMARY BACKGROUND DATA: Pancreatic IPMNs are increasingly recognized, often as incidental findings, especially in people over age 70 and 80. Computed tomography (CT) and magnetic resonance (MR) are unreliable in discriminating a benign from a malignant neoplasm. 18-FDG PET as imaging procedure based on the increased glucose uptake by tumor cells has been suggested for diagnosis and staging of pancreatic cancer. METHODS: From January 1998 to December 2005, 64 patients with suspected IPMNs were prospectively investigated with 18-FDG PET in addition to conventional imaging techniques [helical-CT in all and MR and magnetic resonance cholangiopancreatography (MRCP) in 60]. 18-FDG PET was analyzed visually and semiquantitatively using the standard uptake value (SUV). The validation of the diagnosis was made by a surgical procedure (n = 44), a percutaneous biopsy (n = 2), main duct cytology (n = 1), or follow-up (n = 17). Mean and median follow-up times were 25 and 27.5 months, respectively (range, 12-90 months). RESULTS: Twenty-seven patients (42%) were asymptomatic. Forty-two patients underwent pancreatic resection, 2 palliative surgery, and 20 did not undergo surgery. An adenoma was diagnosed in 13 patients, a borderline tumor in 8, a carcinoma in situ in 5, and an invasive cancer in 21; in 17 patients a tumor sampling was not performed and therefore the histology remained undetermined. Positive criteria of increased uptake on 18-FDG PET was absent in 13 of 13 adenomas and 7 of 8 borderline IPMNs, but was present in 4 of 5 carcinoma in situ (80%) and in 20 of 21 invasive cancers (95%). Conventional imaging technique was strongly suggestive of malignancy in 2 of 5 carcinomas in situ and in 13 of 21 invasive carcinomas (62%). Furthermore, conventional imaging had findings that would be considered falsely positive in 1 of 13 adenomas (8%) and in 3 of 8 borderline neoplasms (37.5%). Therefore, positive 18-FDG PET influenced surgical decision making in 10 patients with malignant IPMN. Furthermore, negative findings on 18-FDG PET prompted us to use a more limited resection in 15 patients, and offered a follow-up strategy in 18 patients (3 positive at CT scan) for the future development of a malignancy. CONCLUSIONS: 18-FDG PET is more accurate than conventional imaging techniques (CT and MR) in distinguishing benign from malignant (invasive and noninvasive) IPMNs. 18-FDG PET seems to be much better than conventional imaging techniques in selecting IPMNs patients, especially when old and asymptomatic, for surgical treatment or follow-up.     

Pancreatic tuberculosis

A 63-year-old Japanese man visited our institute with fever of unknown origin. Findings on preoperative imaging modalities were consistent with pancreatic carcinoma, but a positive tuberculin skin test indicated tuberculosis infection. Negative results for MycobacteriumDNA polymerase chain reaction from sputum and bone-marrow aspiration biopsy specimens ruled out pulmonary and miliary tuberculosis, respectively. Positron emission tomography (PET) with 2-[fluorine-18]-fluoro-2-deoxy- d-glucose (FDG) showed multiple labeled spots within the pancreas body and chest. Distal pancreatectomy was performed with a diagnosis of suspected pancreatic carcinoma, but the histological and microbiological diagnosis was Mycobacterium infection. A rare case of pancreatic tuberculosis evaluated by FDG PET is reported and discussed herein.     

三探头脱氧葡萄糖符合线路断层显像在诊断肺癌中的应用

目的评价三探头脱氧葡萄糖符合线路断层显像(FDGTHTC)诊断肺癌的准确性。方法对比观察109例肺部疾病患者行FDGTHTC检查的结果及其最终病理诊断,按病灶直径(>15cm、≤15cm)分别计算FDGTHTC诊断不同体积病灶的敏感性、特异性、准确性。结果病理检查显示,109例患者中86例为肺癌,23例为良性疾病。全组FDGTHTC的诊断敏感性、特异性、准确性分别为95%(82/86),74%(17/23),91%(99/109)。FDGTHTC诊断的敏感性、特异性、准确性,病灶直径≤15cm者分别为1/3,7/7,8/10,直径>15cm者分别为98%(81/83),63%(10/16),92%(91/99),其中FDGTHTC诊断前者的敏感性明显低于后者,两组间差异有统计学意义(Fisher精确概率法检验,P=0005)。结论FDGTHTC是诊断肺癌较为有用的检查手段,对直径≤15cm的病灶诊断价值较低。     

增强CT和PET/CT对胰腺癌诊断及分期中的价值

目的 探讨增强CT和PET/CT对胰腺癌诊断及分期中的价值.方法 回顾性分析安徽医科大学第一附属医院普外科2009年10月至2013年10月间收治47例手术治疗的胰腺占位患者资料.术前均行CA19-9检查、腹部增强CT扫描及全身PET/CT扫描,比较增强CT与PET/CT在胰腺癌诊断及分期中价值.结果 47例患者中,确诊胰腺癌41例,非胰腺癌6例.CA19-9、增强CT和PET/CT对胰腺癌诊断的灵敏度分别为78.0％、80.4％和95.1％,PET/CT灵敏度优于CA19-9和增强CT,差异有统计学意义（P值分别为0.023和0.043）;在胰周淋巴结转移判断方面,PET/CT和增强CT的灵敏度分别为75.0％和41.6％,二者差异有统计学意义（P=0.019）;在肝转移判断方面,PET/CT和增强CT诊断的灵敏度分别为80.0％和60.0％,二者差异无统计学意义（P=1.0）.结论 PET/CT对胰腺癌诊断有较高灵敏度,显著优于增强CT.当肿瘤SUV值升高,PET/CT诊断仍应注意结合CA19-9、增强CT甚至MRI综合判断;PET/CT有助于发现淋巴结和远处器官转移病灶,获得更加准确的术前分期,从而避免诊断性剖腹探查手术.     

Diagnostic role of [F-18]-FDG positron emission tomography in restaging renal cell carcinoma

AIMS: To retrospectively assess the diagnostic utility of positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) in restaging renal cell carcinoma. MATERIALS AND METHODS: We performed whole-body PET scans (45 minutes after intravenous injection of 10 - 15 mCi FDG) for restaging 25 patients (18 male, 7 female, 42 - 81 years old) with known or suspected metastatic renal cell carcinoma. Prior treatments included immunotherapy (n = 1), nephrectomy (n = 16), nephrectomy followed by chemotherapy (n = 3), by radiation therapy (n = 1), and by combined chemoradiation therapy (n = 4). Contrast-enhanced chest, abdomen and pelvis CT studies were available for all patients. Diagnostic validation was by histological sampling (n = 2) and clinical and imaging follow-up for up to 1 year (n = 23). RESULTS: PET was concordant with the findings of CT in 18 patients (3 TN, 15 TP). PET was discordant with CT in 7 patients (28% of total). PET was falsely negative in 6 of these patients and did not demonstrate hypermetabolism in pulmonary (n = 4), mediastinal (n = 2), adrenal (n = 1) and lytic osseous (n = 2) metastatic lesions. PET was falsely positive in the remaining 1 patient in the discordant group with lumbar facet arthropathy. The diagnostic performance of PET in detection of recurrent and metastatic renal cell carcinoma revealed a sensitivity of 71%, specificity of 75%, accuracy of 72%, negative predictive value of 33% and positive predictive value of 94%. CONCLUSIONS: FDG PET demonstrates modest accuracy in the diagnostic imaging evaluation of patients with suspected or known metastatic renal cell carcinoma. A negative study may not exclude disease while a positive study is suspicious for malignancy.     

F-18-fluorodeoxyglucose positron emission tomography in differentiating malignant from benign pancreatic cysts: A prospective study

The differential diagnosis between benign and malignant pancreatic cystic lesions may be very difficult. We recently found that F-18-.uorodeoxyglucose positron emission tomography (18-FDG PET) was useful for the preoperative work-up of pancreatic cystic lesions. This study was undertaken to confirm these results. From February 2000 to July 2003, 50 patients with a pancreatic cystic lesion were prospectively investigated with 18-FDG PET in addition to helical computed tomography (CT) and, in some instances, magnetic resonance imaging (MRI). The validation of diagnosis was based on pathologic findings after surgery (n = 31), percutaneous biopsy (n = 4), and according to follow-up in 15 patients. The 18-FDG PET was analyzed visually and semiquantitatively using the standard uptake value (SUV). The accuracy of FDG PET and CT was determined for preoperative diagnosis of malignant cystic lesions. Seventeen patients had malignant cystic lesions. Sixteen (94%) showed increased 18-FDG uptake (SUV >2.5), including two patients with carcinoma in situ. Eleven patients (65%) were correctly identified as having malignancy by CT. Thirty-three patients had benign tumors: two patients showed increased 18-FDG uptake, and four patients showed CT findings of malignancy. Sensitivity, specificity, positive and negative predictive value, and accuracy of 18-FDG PET and CT in detecting malignant tumors were 94%, 94%, 89%, 97%, and 94% and 65%, 88%, 73%, 83%, and 80%, respectively. 18-FDG PET is accurate in identifying malignant pancreatic cystic lesions and should be used in combination with CT in the preoperative evaluation of patients with pancreatic cystic lesions. A negative result with 18-FDG PET may avoid unnecessary operation in asymptomatic or high-risk patients. Presented at the Forty-Fifth Annual Meeting of The Society for Surgery of the Alimentary Tract, New Orleans, Louisiana, May 15–19, 2004 (oral presentation). This study was supported by the Ministero Università e Ricerca Scientifica (Cofin 2001068593-001), Rome, Italy.     

胰岛细胞瘤32例诊治分析

目的:探讨胰腺内分泌肿瘤的诊断和外科治疗经验。方法:32例中行肿瘤摘除术18例,胰体尾联合脾切除术4例,胰十二指肠切除术4例,肿瘤切除并胃大部切除术2例,Whipple术3例,捆绑式胰体空肠吻合术1例。结果:B超、CT、MRI、DSA诊断胰岛细胞瘤的敏感性分别为62.5%、75%、80%、87.5%。术后并发症包括胰瘘、切口感染、腹腔内出血。结论:无功能胰岛细胞瘤恶性率显著高于功能性胰岛细胞瘤(P<0.01)。胰腺内分泌肿瘤的外科治疗方案主要取决于肿瘤的大小、定位和恶性度。对良性者宜行单纯肿瘤切除或胰腺部分切除,对恶性肿瘤应以扩大范围的根治性肿瘤切除术为主的综合治疗。     

Predictors of cancer in patients with suspected pancreatic malignancy without a tissue diagnosis

BACKGROUND: The aim of this study was to identify predictive factors for malignancy in patients undergoing surgery for suspected pancreatic cancer without a preoperative tissue diagnosis. METHODS: Patients were identified by International Classification of Diseases Ninth Revision and current procedural terminology codes, respectively, for pancreatic cancer and pancreaticoduodenectomy at a single tertiary referral center between January 1998 and May 2004. Data were collected retrospectively by chart review. Multivariate analysis of potential predictive factors was performed. RESULTS: A total of 150 patients underwent surgery for documented or suspected pancreatic malignancy; 102 did not have a preoperative tissue diagnosis of cancer. Of these, 75 had neoplastic disease at surgery. Average weight loss was greater for those with malignancy (13.5 vs. 4.8 lbs; P = .014) as was mean bilirubin (6.1 vs. 3.3 mg/dL; P = .006). In multivariate analysis, a combination of weight loss >20 lbs, bilirubin >3 mg/dL, and CA 19-9 >37 U/mL had both a specificity and positive predictive value of 100% for predicting malignancy regardless of bile duct abnormalities or mass lesions on endoscopic retrograde cholangiopancreatography or endoscopic ultrasound, respectively. The positive predictive value decreased to 89.5% when any 2 of these findings were present. The presence of a mass on CT or EUS alone had a sensitivity of 84%; however, no other single finding had a sensitivity >65%. CONCLUSIONS: In patients suspected of having a pancreatic malignancy, weight loss, hyperbilirubinemia, and increased CA 19-9 level may be predictive of a final cancer diagnosis. Surgical exploration should be considered in these patients even in the absence of a preoperative tissue diagnosis.