胰腺实性假乳头状瘤的诊治分析

目的:探讨胰腺实性假乳头状瘤的诊断与外科治疗方法。方法:回顾性分析2000年6月—2011年5月间收治的42例胰腺实性假乳头状瘤患者的临床资料。结果:42例中女性41例,男性1例;年龄16~63(平均31.1)岁。肿瘤位于胰头部10例,胰颈部3例,体尾部29例。瘤体最大直径2~15 cm,平均6.3 cm。就诊时无明显症状者20例,仅有上腹部胀痛不适者21例,1例由于肿物破裂出现剧烈腹痛伴发热。超声检查发现胰腺低回声或等回声或囊实混合性包块,CT检查多显示为胰腺区类圆形囊实性肿物,增强后实性部分不同程度强化。患者均行手术切除,经病理证实为胰腺实性假乳头状瘤。其中2例行保留幽门的胰头十二指肠切除术,2例行保留十二指肠的胰头切除术,10例行保留脾脏的胰体尾切除术,13例行胰体尾切除术,14例行局部切除术,1例行姑息切除术。40例患者获随访,随访时间6个月至11年,平均49个月,均存活,无远隔转移病例。1例肿瘤局部切除术后8年局部复发经再次手术局部切除,至今41个月未发现肿瘤复发。结论:年轻女性发生的囊实混合性胰腺肿瘤应高度怀疑胰腺实性假乳头状瘤,该肿瘤为低度恶性,在保证完整切除的前提下尽可能采用保留器官功能的手术方式患者可获长期生存。

Diagnosis and treatment of solid pseudopapillary tumor of the pancreas

Objective: To summarize the experience in diagnosis and treatment of solid pseudopapillary tumor of the pancreas(SPT). Methods: The clinical data of 42 patients with SPT admitted between June 2000 and May 2011 were retrospectively analyzed. Results: Of the 42 patients,41(98%) cases were female and only one case was male,and their ages ranged from 16 to 63(average of 31.1).In nine patients the tumors were located in the head of the pancreas,three were located in the neck and 29 were located in the body and tail.The maximum tumor diameter varied from 2 to15 cm(average of 6.3 cm).Twenty patients had no obvious signs on admission,21 patients had only vague upper abdominal pain or discomfort,and only one case presented with severe abdominal pain and high fever due to tumor rupture.Lesions in the pancreas appeared as hypoechoic,isoechoic,or complex masses(having both cystic and solid components) at ultrasound,and presented as roundish cystic/solid masses on CT scan where the solid component showed different degrees of enhancement after contrast-enhanced imaging.All patients underwent surgical resection and the lesions were confirmed as SPT by intra-and postoperative pathology.Of the patients,two cases underwent pylorus-preserving pancreaticoduodenectomy,two cases had duodenum-preserving pancreatic head resection,spleen-preserving pancreatic body and tail resection was performed in 10 cases,pancreatic body and tail resection in 13 cases,local resection in 14 cases,and one case received palliative resection.Forty patients were followed up for 6 months to 11 years(average of 49 months);all of them were alive and with no distant metastases,and one of them who experienced local recurrence 8 years after local resection underwent a second local resection and survived to date for 41 months. Conclusion: High vigilance should be maintained for SPT in young women with the complex cystic/solid pancreatic masses.Due to low-grade malignancy,patients can obtain long-term survival through complete surgical resection and with organ function preservation as far as possible.