胰腺实性假乳头状瘤的诊断和治疗

目的 总结胰腺实性假乳头状瘤的临床诊治经验,并提出较符合我国国情的诊治流程.方法 回顾性分析2001年1月至2007年3月收治的50例胰腺实性假乳头状瘤患者的临床资料.其中男3例,女47例;中位年龄24岁(13～60岁).术前B超、CT等检查均有特征性影像学表现,血清肿瘤标志物多为阴性.肿瘤位于胰头部23例、胰颈部3例、钩突部2例、胰体部3例、胰尾部18例、原发病灶位置不明1例.48例患者行手术切除肿瘤,1例行剖腹探查术,1例行CT引导下转移病灶穿刺活组织检查术.结果 50例患者中49例获得了"胰腺占位"的术前诊断.32例肿瘤包膜完整的患者有18例、16例肿瘤包膜不完整患者有11例未行冷冻病理检查而直接选择相应术式.32例患者随访3～55个月,均未发现肿瘤复发、转移.结论 胰腺实性假乳头状瘤多发于青年女性,CT检查结果最具诊断价值,外科手术切除肿瘤是首选治疗方式,预后良好.常用的术式为保留十二指肠的胰头切除术与胰体尾+脾切除术.肿瘤包膜是否完整,决定是否行术中冷冻病理检查和指导手术方式的选择.最常见的并发症为胰瘘.

Diagnosis and treatment of solid-pseudopapillary tumor of pancreas

Objective To summarize the clinical experience of diagnosis and treatment of solid-pseudopapillary tumor of pancreas(SPTP),and to work out the diagnosis and treatment process which matches the conditions of China.Methods The clinical data of consecutive 50 patients with SPTP who had been admitted to our hospital from January 2001 to March 2007 were retrospectively analyzed.Of all patients,3 were male and 47 female.Their median age Was 24 years(13-60 years).Preoperative imaging examination revealed typical findings and tumor markers were negative.SPIP of 23 cases were located in the head of pancreas,3 in the neck of pancreas,2 in the uncinate process of pancreas.3 in the body of pancreas,18 in the tail of pancreas,and the location of SPTP of 1 case was uncertain.Forty-eight patients underwent the operation of SPTP resection,1 of exploratory laparotomy and 1 of CT-guided fine-needle aspiration biopsy of metastatic lesions.Results Forty-nine out of 50 patients were diagnosed"pancreatic mass"preoperatively.Eighteen of the 32 patients with intact tumor capsule and 11 of the 16 patients without intact tumor capsule underwent operation without pathological examination.Thirty-two patients were followed up for 3-55 months,and no metastasis or invasion of the SPTP was observed.Conclusions Yong females are in the high risk group of SPTP.CT is the most valuable preoperative imaging test.Complete surgical resection is the first choice treatment with good prognosis.Resection of the head of pancreas with the preservation of duodenum and resection of body and tail of pancreas+splenectomy are the commou modalities used for the treatment of SPTP.The intactness of the tumor capsule is an important factor in making surgical plan and deciding the necessity of intraoperative frozen section pathological examination.The most common postoperative complication of SPTP resection is pancreatic fistula.