胰腺囊性肿瘤的诊断与治疗

目的探讨胰腺囊性肿瘤的诊断和治疗。方法回顾性分析2008年1月-2012年7月间56例本院胰腺囊性肿瘤患者的临床资料,男性15例,女性41例,男女比例为1：2.73,其中浆液性囊腺瘤12例,黏液性囊腺瘤22例,黏液性囊腺瘤癌6例,导管内乳头状囊腺瘤3例和乳头状囊腺瘤癌1例,实性假乳头状瘤12例。结果所有患者均经手术治疗,胰十二指肠切除术13例,胰腺肿瘤节段切除术4例,1例因肿瘤侵及周围脏器及大血管行胃空肠及胆肠吻合术,1例行胰腺钩突部肿瘤切除、部分十二指肠空肠切除、十二指肠空肠吻合术,胰腺肿瘤局部切除术3例,胰体尾切除术18例,保留脾脏的腹腔镜胰体尾切除术8例,腹腔镜胰体尾加脾切除2例,腹腔镜胰腺肿瘤局部切除术6例。本组无围手术期死亡,腹腔感染2例,胃排空障碍3例,胰瘘4例,胆漏2例,均经保守治疗痊愈。结论 B超、CT和MRI是胰腺囊性肿瘤的主要诊断方法,具体手术方式应根据肿瘤所在部位、病理类型、与主胰管的关系以及患者全身情况综合考虑。

Diagnosis and treatment of pancreatic cystic tumors

Objective To study the diagnosis and treatment of pancreatic cystic tumor.Methods Clinical data about 56 patients with pancreatic cystic tumor（15 males,41 females） admitted to our hospital from January 2008 to July 2012 were retrospectively analyzed.The male and female ratio was 1：2.73.Of these patients,12 were diagnosed with serous cystic tumor,22 with mucinous cystic tumor,6 with mucinous cystic carcinoma,3 with intraductal papillary mucinous tumor,1 with intraductal papillary mucinous carcinoma,and 12 with solid pseudopapillary tumor.Results Of the 56 patients,13 underwent pancreatoduodenectomy,4 pancreatic tumor segment resection,1 gastrojejunal and biliary enteric anastomosis due to tumor invasion of its adjacent organs and large vessels,1 pancreatic uncinate tumor resection,partial duodenojejunal resection and anastomosis,3 pancreatic body and tail tumor resection,18 pancreatic body and tail resection,8 laparoscopic pancreatic body and tail resection with spleen reserved,2 laparoscopic pancreatic body and tail resection plus spleenectomy,and 6 laparoscopic pancreatic tumor resection.No death occurred during perioperative period.Abdominal cavity infection,gastric empting disturbance,pancreatic fistula and bile leakage occurred in 2,3,4 and 2 patients,respectively,which were cured after conservative treatment.Conclusion Ultrasound,CT and MRI are the main diagnostic means of pancreatic cystic tumor.Specific surgical procedure for pancreatic cystic tumor should be decided according to its site,histological type,relation with the main pancreatic duct and general condition of the patients.