胰腺良性肿瘤23例临床治疗分析

目的 探讨胰腺良性肿瘤的诊断与治疗,手术方式的选择,术后并发症的防治.方法 回顾性分析我院2004年1月至2009年12月收治的23例胰腺良性肿瘤患者的临床资料.患者均接受外科手术治疗.5例行肿瘤摘除术,8例行胰体尾脾脏切除术,1例行胰腺中段切除术,5例行胰十二指肠切除术,4例行胰腺囊肿空肠R-Y吻合内引流术.18例患者手术后应用了生长抑素.结果 本组术后病理诊断:胰腺囊肿8例,胰岛细胞瘤4例,黏液性囊腺瘤6例,浆液性囊腺瘤3例,实质性假乳头状瘤2例.10例发生胰瘘的患者有7例出现继发的腹腔感染.死亡1例,死于胰十二指肠切除术后多脏器功能衰竭.结论 胰腺良性肿瘤无特异性症状和血清学实验室检查,CT及内窥镜下逆行性胰胆管造影术(ERCP)对临床诊断治疗有很大帮助.手术方式的选择取决于肿瘤生长部位及术中对肿瘤良恶性的判断,可行胰十二指肠切除术、胰腺中段切除术、保留或不保留脾脏的胰体尾切除术及肿瘤摘除术.胰瘘是手术后主要的并发症.可靠结扎主胰管、妥善处理胰腺创面、胰液外引流可以降低胰瘘发生率.

Analysis of clinical treatment of pancreatic benigntumors: a report of 23 cases

Objective To discuss the diagnosis and treatment of the benign tumors of pancreas,especially the surgical options and the prevention and cure of the postoperative complications.Methods Clinical data of 23 patients with benign lesions of the pancreas were retrospectively analyzed in our hospital from Jan.2004 to Dec.2009.All of the patients underwent surgical operation.Five patients were treated with pancreatic enucleation,8 patients were treated with distal pancreatectomy with splenectomy,1 patient was treated with central pancreatectomy,5 patients were treated with pancreaticoduodenectomy,4 patients were treated with pancreatic cyst- jejunum R-Y anastomosis.Eighteen patients were treated with somatostatin analogue.Results The pathological diagnosis included pancreatic cyst in 8,islet cell tumor in 4,mucous cystadenomas in 6,serous cystadenomas in 3,solid-pseudopapillary tumor in 2.Seven of 10 cases having pancreatic leak occoured secondary abdominal infection.One patient died of multiple organ dysfunction syndrome after pancreaticoduodenectomy.Conclusion There is no specific symptoms and serologic laboratory examinations for pancreatic benign tumors.CT and ERCP is very helpful for diagnosis and treatment.Surgical option is according to the location of the lesion and the judgement of the tumor whether being benign or malignant.Pancreaticoduodenectomy,central pancreatectomy,distal pancreatectomy with or without splenectomy and pancreatic enucleation is the reasonable surgical option.Pancreatic leakage is the main post-operation complication.Ligation the pancreatic duct reliably,treating the pancreatic raw surface appropriately,external drainage of the pancreatic fluid can reduce the rate of pancreatic leakage.