胰腺囊性肿瘤的诊断和治疗34例

目的:探讨胰腺囊性肿瘤的临床诊治特点.方法:回顾性分析1980.2006年我院收治的34例胰腺囊性肿瘤患者的临床资料.结果:胰腺囊性肿瘤常见症状为腹痛,腹部包块,腹胀和上腹不适.各项检查及确诊率分别为:B超50%,CT 66.7%和MRI 80%.全组病例皆行手术治疗,手术切除率82.4%.手术并发症主要为胰瘘和脾窝积液.21例囊腺瘤生存,未见复发.1例黏液性囊腺瘤术后90 mo复发.1例导管内乳头状囊腺癌随访39 mo生存.黏液性囊腺癌中3例分别随访7,27和76 mo健在,2例分别在术后2 mo和4 mo出现腹腔转移.l例术后27 mo肿瘤复发死亡.结论:胰腺囊性肿瘤缺乏特异性临床表现.CT和MRI是主要诊断方法,联合应用影像手段可以提高确诊率.手术切除是主要治疗手段.大于5CM的浆液性囊性肿瘤建议手术治疗.未明性质的胰腺囊性肿瘤应积极手术探查.     

胰腺囊性肿瘤15例诊治分析

目的探讨胰腺囊性肿瘤的临床病理特点及诊治方法。方法对2004～2009年我院收治的均经手术和病理检查证实为胰腺囊性肿瘤的15例临床资料进行回顾性分析。结果 15例病人中浆液性囊腺瘤3例,黏液性囊腺瘤7例,囊腺癌5例。浆液性囊腺瘤较黏液瘤和囊腺癌小(P<0.05)。5例血清CAl99明显升高(胰腺囊腺癌4例,胰腺黏液性囊腺瘤1例)(正常参考范围1～39 u/L),提示CAl99是鉴别胰腺囊性肿瘤良恶性的较好标志物。5例肿物位于胰头部,1例肿物位于胰体部,2例肿物位于胰体尾部,7例肿物位于胰尾部。全部病人均接受了手术治疗。肿物位于胰头者行胰、十二指肠切除术5例;肿物位于胰体者行胰腺节段切除加胰腺远端空肠Roux-en-Y吻合术1例;肿物位于胰体尾者行肿物摘除术2例;肿物位于胰尾者行肿物摘除术2例,胰体尾切除术2例,胰体尾及脾切除术2例,胰体尾切除、脾切除及肝转移瘤切除术1例。与病理诊断相比,术前诊断误诊率26.7%,手术术中诊断误诊率20%。全组无围手术期死亡者,预后良好。结论临床中胰腺囊性肿瘤的病史询问,病理学特征,B超及CT检查,囊液分析及组织活检有助于明确诊断,手术切除是唯一有效的治疗方法,疗效满意。     

胰腺囊性肿瘤的鉴别诊断（附10例分析）

胰腺囊性肿瘤是一种很少见的胰腺肿瘤，约占全部胰腺肿瘤的11％～15％，其中大部分病情发展慢，治疗效果好，有别于胰腺实质性癌肿。主要包括胰腺囊腺瘤、胰腺囊腺癌、胰腺乳头状囊性肿瘤及胰实质性肿瘤的缺血液化或感染所致的退行性病理改变。现将我们近年来收治的10例胰腺囊性肿瘤诊疗情况总结报告如下。     

胰腺囊腺瘤局部摘除术

目的 探讨胰腺囊腺瘤局部摘除的可行性.方法 对2001年1月至2007年12月中国医科大学附属第一医院普通外科行摘除术的11例胰腺囊腺瘤患者进行回顾性分析.结果 11例胰腺囊腺瘤中男2例,女9例,平均年龄47岁.肿瘤直径平均4.8 cm,位于胰头部1例,胰体尾10例.病理证实浆液性囊腺瘤3例,黏液性囊腺瘤8例.3例患者术后出现一过性血糖增高,1～2周恢复正常,1例切口感染,2例术后发生胰瘘.术后随访28～67个月,1例术后3年发现胰体部假性囊肿,其他患者肿瘤无局部复发,无糖尿病发生.结论 对于直径<6cm的胰腺囊腺瘤患者行肿瘤摘除术是安全可行的.     

胰腺浆液性囊腺瘤21例临床及病理分析

目的 探讨胰腺浆液性囊腺瘤(SCAP)的临床与病理特点.方法 回顾性分析21例SCAP患者的临床及病理资料.结果 21例SCAP患者的平均年龄为61岁,男∶女为1∶1.33,18例(85.7％)有腹痛、腹胀、腹部包块、消瘦等症状,3例(14.3％)为体检发现.肿瘤位于胰头部9例,胰体尾部12例.临床表现均为胰腺囊性占位.21例患者均行手术治疗.病理检查见囊壁完整,内衬扁平或立方上皮细胞,胞质透亮,核圆形或卵圆形,大小一致,无明显核异型和核分裂象,病理诊断为微囊型15例、寡囊型6例.免疫组化显示肿瘤细胞EMA、CK7、CK19均阳性,碘酸-雪夫(PAS)染色亦阳性,Ki-67阳性表达率在1％ ～3％之间.19例经3个月到7年不等的随访未发现复发及转移.结论 SCAP好发于老年女性,多数患者有临床症状.SCAP多位于胰体尾部,表现为胰腺导管上皮分化特征.患者预后良好.     

囊液分析在胰腺囊性病变鉴别诊断中的价值

胰腺囊性病变包括假性囊肿(pseudocysts,PC)和囊性肿瘤。近些年由于CT影像技术的发展,胰腺囊性病变的诊断率明显提高。胰腺囊性肿瘤仅占胰腺囊肿的10%～15%[1],但种类繁多,并且具有良性、交界性及恶性的不同程度分化,其中最常见的病变类型为:浆液性囊腺瘤(serous cystade-nomas     

胰腺囊腺瘤与囊腺癌39例的CT影像学特征

目的 探讨胰腺囊腺瘤与囊腺癌的CT影像学特征.方法 回顾性分析经过病理证实的21例浆液性囊腺瘤、12例黏液性囊腺瘤、6例黏液性囊腺癌的CT影像学资料,分析肿瘤部位、单(多)囊、最大囊直径、囊壁特征、囊内分隔、肿瘤边界、肿瘤与胰管关系等影像学征象.结果 21例浆液性囊腺瘤中17例位于胰头颈部,5例位于胰体尾部,其中1例为多发;均为多囊,平均最大囊直径为1.8 cm;4例囊壁或分隔有钙化,7例分隔可见软组织成分;10例胰管轻度增宽.12例黏液性囊腺瘤中6例位于胰头颈部,6例位于胰体尾部;4例为多囊,平均最大囊直径为4.5 cm;1例分隔可见钙化,6例囊壁可见软组织成分;2例胰管扩张,3例胰管轻度增宽.6例黏液性囊腺癌中5例位于胰体尾部,1例位于胰头颈部;4例为多囊,平均最大囊直径为5.1 cm;1例分隔可见钙化,5例囊壁可见软组织成分;1例胰管扩张,1例胰管轻度增宽.所有病灶与胰管均不相通,增强后病灶软组织成分及分隔均有不同程度强化.结论 胰腺囊腺瘤与囊腺癌的CT表现具有一定的特征性,但对于少数不典型表现病例,诊断仍存在困难.     

多层螺旋CT对胰腺囊腺瘤及囊腺癌的诊断价值

目的分析胰腺囊腺瘤及囊腺癌的MSCT表现,提高其诊断水平。方法分析经手术病理证实的18例胰腺囊腺瘤及囊腺癌患者的MSCT表现。结果浆液性囊腺瘤8例,表现为多房2例：中央可见星芒状钙化,增强后分隔强化;表现为单房囊性病灶6例：边缘分叶,增强后病变无强化。黏液性囊腺瘤5例,2例表现为圆形或椭圆形单房囊性病灶,3例呈多房分隔囊性病灶,增强后壁有强化。5例囊腺癌患者肿瘤呈多房分隔囊性病灶,增强后壁结节及分隔强化,其中4例伴肝脏转移及1例伴邻近血管受侵征象。结论MSCT能很好显示胰腺囊腺瘤及囊腺癌内部结构及邻近脏器、血管受累改变,对其诊断及鉴别诊断具有重要价值。     

胰腺囊腺癌的诊断和治疗

胰腺囊腺癌属临床少见病,多由胰腺囊腺瘤恶变而来,易与囊腺瘤及胰腺假性囊肿相混淆。１９８９～１９９９年,我们收治３例胰腺囊腺癌患者,现报告如下。１ 临床资料本组男２例、女１例,年龄分别为４１、４６和６８岁。均因上腹隐痛、腹胀入院,病程６个月至２年。其中１例入院前３个月曾误诊为胰腺假性囊肿接受剖腹探查、胰腺囊肿内引流术。查体除１例有明显贫血、呈恶病质外,另２例一般情况好。３例患者均有腹部膨隆,分别在上腹部扪及一８ｃｍ×７ｃｍ×６ｃｍ、　　２０ｃｍ×２０ｃｍ×２０ｃｍ和６ｃｍ×５ｃｍ×５ｃｍ大肿块,质…     

胰腺肿瘤的诊断及治疗：胰腺囊性病变

随着影像学技术的进步及人群健康查体意识的提高，无症状的胰腺囊性病变患者逐渐增多。胰腺囊性病变主要包括浆液性囊腺瘤（SCA）、黏液性囊腺瘤（MCA）、胰腺假性囊肿、潴留囊肿、导管内乳头状黏液性肿瘤（IPMN）、囊腺癌等。其中黏液性囊腺瘤和IPMN均被视为癌前病变。胰腺囊性病变患者绝大多数无临床症状，仅20％左右表现为上腹部隐痛、腹胀、消化道症状等，缺乏特异性；体格检查也多无阳性体征。是囊肿的某些特征和恶性肿瘤之间有相关性，这些特征包括存在实性占位性病变、囊肿增大和出现症状。     

胰腺囊性肿瘤的诊断与治疗——附41例报告

目的探讨胰腺囊性肿瘤的诊断和治疗。方法对本院1990年6月至2004年6月收治的41例胰腺囊性肿瘤患者的临床特点进行回顾性分析。结果胰腺囊性肿瘤好发于中青年女性，无急性胰腺炎，无上腹部手术及外伤史。临床表现以上腹部肿块和疼痛不适较为多见。影像学检查胰腺肿块为囊性，囊实性或不规则分叶状。肿瘤位于胰头部14例，胰体尾部27例。行不同术式的肿瘤切除35例，内引流3例，剖腹探查、肿瘤活检2例，1例拒绝于术治疗。有效随访34例，随访12个月～13年，22例囊腺瘤，17例仍生存；12例囊腺癌，生存时间〈12个月2例，12个月至2年4例，6例健在，其中5年以上3例，最长1例已生存7年。结论提高对胰腺囊性肿瘤的认识，减少误诊和积极的手术切除是改善其预后的主要措施。     

Diagnostic dilemmas in patients with cystic neoplasms of the pancreas

Summary Cystic neoplasms of the pancreas (CNP) are rare lesions that can be difficult to diagnose preoperatively. Twenty patients with cystic neoplasms of the pancreas including five microcystic adenomas, six benign mucinous cystic neoplasms, three malignant mucinous cystic neoplasms, two solid and papillary epithelial neoplasms, and four cystic neuroendocrine tumors were treated at a single institution between 1962 and 1987. The average duration of symptoms prior to diagnosis was 10 months. Five patients were asymptomatic. Forty percent of patients presented with an abdominal mass. Plain abdominal x-rays and UGI barium contrast studies were never diagnostic. Ultrasonography, computerized tomography (CT) and visceral angiography aided in the correct diagnosis in 28%, 36%, and 75% of patients studied, respectively. Overall a correct diagnosis was made preoperatively in only 35% of patients. Twelve of 13 patients were correctly diagnosed at laparotomy with intraoperative biopsy. Without biopsy the mass was misdiagnosed at laparotomy in five of six cases. CNP must be suspected inany patients who present with an upper abdominal mass with or without abdominal pain and no history of pancreatitis. CT may be diagnostic in up to one third of cases and should be obtained routinely to demonstrate the proximity of the lesion to other structures. Visceral angiography should also be obtained prior to operation. A generous incisional biopsy should be obtained of all pancreatic cysts that are not to be resected.     

Cystic neoplasms of the pancreas： A diagnostic challenge

Cystic neoplasms of the pancreas are increasingly recognized due to the expanding use and improved sensitivity of cross-sectional abdominal imaging. Major advances in the last decade have led to an improved understanding of the various types of cystic lesions and their biologic behavior. Despite significant improvements in imaging technology and the advent of endoscopic-ultrasound （EUS）-guided fine- needle aspiration, the diagnosis and management of pancreatic cystic lesions remains a significant clinical challenge. The first diagnostic step is to differentiate between pancreatic pseudocyst and cystic neoplasm. If a pseudocyst has been effectively excluded, the cornerstone issue is then to determine the malignant potential of the pancreatic cystic neoplasm. In the majority of cases, the correct diagnosis and successful management is based not on a single test but on incorporating data from various sources including patient history, radiologic studies, endoscopic evaluation, and cyst fluid analysis. This review will focus on describing the various types of cystic neoplasms of the pancreas, their malignant potential, and will provide the clinician with a comprehensive diagnostic approach.     

Management of mucinous cystic neoplasms of the pancreas

The purpose of this study was to investigate the actual management of mucinous cystic neoplasm (MCN) of the pancreas. A systematic review was performed in December 2009 by consulting PubMed MEDLINE for publications and matching the "pancreatic mucinous cystic neoplasm", "pancreatic mucinous cystic tumour", "pancreatic mucinous cystic mass", "pancreatic cyst", and "pancreatic cystic neoplasm" to identify English language articles describing the diagnosis and treatment of the mucinous cystic neoplasm of the pancreas. In total, 16 322 references ranging from January 1969 to December 2009 were analysed and 77 articles were identified. No articles published before 1996 were selected because MCNs were not previously considered to be a completely autonomous disease. Definition, epidemiology, anatomopathological findings, clinical presentation, preoperative evaluation, treatment and prognosis were reviewed. MCNs are pancreatic mucinproducing cysts with a distinctive ovarian-type stroma localized in the body-tail of the gland and occurring in middle-aged females. The majority of MCNs are slow growing and asymptomatic. The prevalence of invasive carcinoma varies between 6% and 55%. Preoperative diagnosis depends on a combination of clinical features, tumor markers, computed tomography (CT), magnetic resonance imaging, endoscopic ultrasound with cyst fluid analysis, and positron emission tomography-CT. Surgery is indicated for all MCNs.     

胰腺囊性肿瘤19例的诊断与外科治疗

目的 探讨胰腺囊性肿瘤的诊断及外科治疗方法.方法 对我院普外科2000年1月至2009年8月诊治的19例胰腺囊性肿瘤的临床资料进行回顾性分析.结果 胰腺囊性肿瘤无特征性临床表现,B超和CT是其主要诊断手段,但均不能准确区分其病理类型,与术后病理对照的定性诊断符合率分别为57.9%(11/19)和68.4%(13/19).肿瘤位于胰头颈部5例,胰体尾部14例,最大直径3～15cm.19例均行手术治疗,切除肿瘤16例,总切除率为84.2%.术中误诊误治4例(21.0%).病理证实浆液性囊腺瘤6例,黏液性囊腺瘤6例,黏液性囊腺癌5例,导管内乳头状黏液腺瘤2例.获得随访15例(78.9%),3例囊腺癌患者中1例切除者已存活4年,无复发;2例未切除者分别于术后4个月和7个月病死.12例囊腺瘤患者目前均存活,肿瘤无复发.失访4例,囊腺癌和囊腺瘤各2例.结论 加强对胰腺囊性肿瘤的认识是减少误诊误治的关键;胰腺囊性肿瘤手术切除后疗效满意,故一经诊断即应积极行外科手术切除.     

胰腺黏液性囊性肿瘤125例临床特征分析

目的 分析胰腺黏液性囊性肿瘤(MCN)的临床特征,提高对该疾病的认识.方法 采用单中心回顾性研究,分析上海长海医院2000年1月至2013年12月期间手术治疗的125例MCN的临床资料,总结其临床特征.结果 125例MCN中,女性112例,男性13例,女:男为8.6:1,年龄25 ～ 77岁,平均(48 ±14)岁.38例(30.4％)患者无症状,87例(69.6％)有症状,以腹痛最常见(81.6％).肿瘤位于胰体尾部111例(88.8％),肿块平均直径(6.3±3.4)cm(1～ 20 cm).85例(68.0％)为多房结构.均不与胰管相通.术前影像学检查正确诊断率为27.2％.15例MCN在内镜超声引导下细针穿刺行细胞或组织病理学检查,其中14例(93.3％)囊液CEA＞800 μg/L.手术方式以胰体尾切除术为主,共102例(81.6％).组织病理学分级示MCN伴轻-中度异型增生110例(88.0％),伴重度异型增生2例(1.6％),伴浸润性癌13例(10.4％).非浸润性MCN术后2、5年生存率均为100％,浸润性MCN术后2、5年生存率均为54.0％.结论 MCN主要发生在中年女性,多位于胰腺体尾部,腹痛为主要症状,术前诊断较为困难,治疗以手术为主,非浸润性MCN可治愈.     

Mucinous cystic neoplasms of the pancreas: pathology and molecular genetics

Mucinous cystic neoplasm (MCN) of the pancreas is a distinct clinicopathological entity characterized by mucin-producing epithelial and cyst-forming neoplasm with “ovarian-type” stroma beneath the epithelial component. It is clearly distinguished from ductal adenocarcinoma and intraductal papillary mucinous neoplasm (IPMN). However, MCN can progress to infiltrating carcinoma, and frequently shows a similar histological pattern to ductal adenocarcinoma. Several genetic alterations such as K-ras oncogene mutation, and epigenetic alterations such as hypermethylation of p16 in the invasive component of MCN are also common with ductal adenocarcinoma. Furthermore, recent technologies, including a laser-assisted microdissection system for histological slides and global gene expression profilings using DNA microarrays, made possible to identify more information about molecular abnormalities of MCNs. It is important to diagnose the lesions before they progress to an invasive carcinoma. MCN is one of the precursors of invasive pancreatic carcinoma.     

胰腺腺泡细胞癌10例临床分析

目的 探讨胰腺腺泡细胞癌的组织学特点、生物学特征、治疗方法及预后.方法 回顾性分析1999至2008年间收治的10例胰腺腺泡细胞癌患者的临床特点、影像学改变、病理学特征、治疗经过及随访资料.结果 10例胰腺腺泡细胞癌患者中男9例,女1例,平均年龄(62±8)岁.CT检查示肿瘤位于胰腺钩突部1例,胰头7例,胰体尾2例;肿瘤大小平均为4.5 cm ×4.7 cm;7例胆总管和肝内胆管明显扩张、胰管扩张;2例侵犯肠系膜上静脉.行胰头十二指肠切除术8例,其中3例合并扩大淋巴结清扫术,2例合并门静脉切除置换;2例行胰体尾+脾切除.病理检查示瘤体平均4.0 cm×3.3cm×3.4 cm;镜下见5例胰头肿瘤侵犯十二指肠,2例侵犯肠系膜上静脉;7例肿瘤侵犯神经;6例淋巴结转移.随访9例,1例失访.术后存活3～51个月,平均存活18个月,均死于肿瘤复发和转移.结论 胰腺腺泡细胞癌是胰腺一个独立的高度恶性的类型,对放化疗可能都不敏感,其生物学特征有待进一步研究.     

Solid pseudopapillary tumor of the pancreas in male patients: Report of 16 cases

AIM:To investigate the clinical characteristics,surgical strategies and prognosis of solid pseudopapillary tumors(SPTs)of the pancreas in male patients.METHODS:From July 2003 to March 2013,116 patients were diagnosed with SPT of the pancreas in our institution.Of these patients,16 were male.The patients were divided into two groups based on gender:female(group 1)and male(group 2).The groups were compared with regard to demographic characteristics,clinical presentations,surgical strategies,complications and follow-up outcomes.RESULTS:Male patients were older than female patients(43.1±12.3 years vs 33.1±11.5 years,P=0.04).Tumor size,location,and symptoms were comparable between the two groups.All patients,with the exception of one,underwent complete surgical resection.The patients were regularly followed up.Themean follow-up period was 58 mo.Two female patients(1.7%)developed tumor recurrence or metastases and required a second resection,and two female patients(1.7%)died during the follow-up period.CONCLUSION:Male patients with SPT of the pancreas are older than female patients.There are no significant differences between male and female patients regarding surgical strategies and prognosis.