胰腺实性假乳头状瘤的诊断和治疗（附28例报告）

目的 总结分析胰腺实性假乳头状瘤（SPTP）的临床特点和治疗效果,提高对该病的认识.方法 回顾性总结2000年10月至2013年3月间经手术和病理证实的28例SPTP病人的临床资料,并对其进行随访.结果 28例中,体检中无意发现肿物者12例,外伤后腹痛检出肿物者6例（均为未成年病人）,腹痛为首发症状者7例,复查意外发现者2例,肠梗阻为首发症状者1例.手术方式：肿物核除术5例;胰十二指肠切除术4例;胰尾切除术5例;胰体尾切除术3例;胰尾切除加脾脏切除术3例;病理活检2例;转移瘤切除1例;胰体切除、胰肠吻合术3例.位于胰头：8例,胰体：4例,胰尾：15例;其他腹壁转移：1例.表现为囊实混合性者22例.所有病人术后均未辅助放化疗治疗.28例病人中2例失访,26例获随访,随访时间为3个月至10年,平均15个月.4例复发,其中1例复发后3个月因合并心肺功能衰竭死亡,另3例经再次手术后治愈.余22例预后良好.本组5年生存率为96.4％.结论 SPTP无特异性临床表现,起病隐匿,CT及彩超对SPTP有诊断意义,手术切除肿瘤为SPTP的主要治疗方式,不经术前术后放疗和化疗,预后良好.

Diagnosis and surgical treatment of pancreatic solid pseudopapillary tumor: a report of 28 cases

Objective To summarize the clinical characteristics and treatment outcomes of pancreatic solid pseudopapillary tumor and improve its awareness.Methods At our hospital between October 2000 to March 2013,a retrospective review was conducted for the clinical data for 28 cases of surgically and pathologically confirmed pancreatic solid false papilloma.Results On physical examination,tumor was accidentally discovered in 12 cases.And post-traumatic abdominal masses were detected in 6 minors.Abdominal pain was the initial symptom in 7 cases.On re-examination,there were 2 cases of accidental discovery.And intestinal obstruction was the initial symptom in 1 case.Surgical approaches：in addition to tumor surgery,there were nuclear resection （n =5）; pancreaticoduodenectomy （n =4）,tail of pancreas resection （n =5）,pancreatic resection （n =3）,tail of pancreas resection splenectomy （n =3）,biopsy （n =2）,metastatic lesion resection （n =1） and pancreatic body resection ＆ pancreaticojejunostomy （n =3）.The sites included head （n =8）,pancreatic body （n =4） and pancreatic tail （n =15） and other abdominal metastasis （n =1）.Mixed cystic and solid compositions were found in 22 cases.None of them received adjuvant chemoradiation therapy.Two were lost while another 26 cases had an average follow-up period of 15 （3-120） months.Among 4 recurrent cases,one case died from heart and lung failure at 3 months.Another 3 cases were cured after re-operation.And prognosis was fair for another 22 cases.The 5-year survival rate was 96.4％.Conclusions With an insidious onset,pancreatic solid false papilloma has no specific clinical manifestations.Computed tomography and ultrasound aid its diagnosis.Surgical removal of tumor remains a key treatment.Without preoperative and postoperative radiotherapy and chemotherapy,the prognosis is generally good.