38例胰腺囊性肿瘤的临床诊断及外科治疗

目的探讨胰腺囊腺瘤、囊腺癌的诊断和治疗方法.方法对1980年1月～2005年4月中国医科大学附属第一医院收治的38例胰腺囊腺瘤和囊腺癌患者的临床表现、检查、手术方式及预后进行了分析.结果胰腺囊腺瘤、囊腺癌主要发生在胰体尾部（79%）,女性多见（84%）,肿瘤无特异性临床表现.超声和CT是主要的影像学检查方法,本组病例超声的诊断率为66%,CT为78%,血清肿瘤标志物检查对诊断意义不大.38例胰腺囊腺瘤、囊腺癌中行胰十二指肠切除2例,保留十二指肠的胰头切除1例,胰体部分切除1例,胰体尾切除21例,肿瘤摘除8例.手术切除的28例胰腺囊腺瘤中25例获得随访,2例因其他疾病死亡,23例健在.8例胰腺囊腺癌手术切除5例,4例获得随访,3例存活.手术后胰瘘的发生率为28%.结论胰腺囊腺瘤手术切除后可以达到治愈,囊腺癌切除后也有较高的生存率.术中病理检查是术式选择的关键,对于诊断明确的良性肿瘤可行胰腺局部切除术,或行肿瘤摘除术.     

胰腺囊腺瘤和囊腺癌的临床病理特点及诊治体会

目的探讨胰腺囊腺瘤和囊腺癌的临床病理特点及其诊治方法。方法回顾性分析1996年6月—2007年3月收治的17例患者的临床病理资料。结果全组临床表现无特征性。B超和CT检查能发现囊肿但不能确定类型。浆液性囊腺瘤7例均行肿瘤局部切除,黏液性囊腺瘤6例行胰十二指肠切除1例,胰体尾切除5例;囊腺癌4例行胰十二指肠切除加淋巴结清扫1例,胰体尾切除术2例,胰体尾加脾切除1例。病理标本多呈多房囊腔,囊腔与胰管不通。15例获得随访,中位随访时间43(1～129)个月,1例囊腺癌行胰体尾加脾切除的老年患者术后6个月营养不良衰竭死亡;其余患者均生存,经B超检查均未见肿瘤复发,仅1例胰十二指肠切除术后患者出现糖尿病,疗效满意。结论B超和CT是该病的主要影像检查方法。加强对该病临床病理特征的认识是提高诊治率的关键,手术切除治疗疗效满意。     

Mucinous cystic neoplasm of the pancreas with latent malignancy

Mucinous cystic neoplasms of the pancreas are rare. They have traditionally been classified as cystadenoma or cystadenocarcinoma. Over a 5-year period, and three operations, a patient initially diagnosed as having a cystadenoma of the pancreas was subsequently found at the time of definitive total pancreatectomy to have a cystadenocarcinoma. The recent literature suggests that there is not distinction between cystadenoma and cystadenocarcinoma, since these tumors have been shown to contain coexisting areas of malignant and benign epithelium in both types. The authors' experience with this patient demonstrates the necessity for thorough histologic sectioning of these tumors to document the presence of carcinoma, since all of these tumors should be regarded as potentially malignant neoplasms. Surgical therapy for these lesions should be total excision whenever feasible.     

无症状胰腺肿瘤的诊断与治疗

目的:探讨无症状胰腺肿瘤的诊断与治疗经验。方法:回顾性分析意外发现的无症状胰腺肿瘤的临床资料。结果:本组38例,男14例,女24例。肿瘤位于胰头者17例,胰体尾者21例。所有病例均行手术切除,包括胰十二指肠切除术11例,保留十二指肠的胰头切除术3例,肿瘤局部切除术1例,节段性胰腺切除术8例,胰体尾、脾切除术15例。术后病理:胰腺导管癌5例,无功能胰岛细胞瘤13例(其中2例恶性),浆液性囊腺瘤8例,黏液性囊腺瘤8例,囊腺癌1例,恶性胰腺导管内乳头状黏液性肿瘤2例,胰腺实性假乳头状瘤1例。恶性肿瘤共10例,占26.3%(10/38)。随访表明,除3例胰体癌术后6个月后死于肝转移外,其余已健康生存11个月～8年至今。结论:无症状胰腺肿瘤大部为良性肿瘤,部分为恶性肿瘤,应予积极手术治疗。手术切除率高,预后良好。     

胰腺囊腺瘤和囊腺癌的诊断及外科治疗

目的探讨胰腺囊腺瘤和囊腺癌的诊断和治疗方法。方法对2000年6月～2005年6月复旦大学附属中山医院收治的24例胰腺囊腺瘤和囊腺癌的临床资料进行回顾性分析。结果胰腺囊腺瘤和囊腺癌无特征性临床表现。B超和CT对胰腺囊性肿瘤的诊断正确率分别达到88%(21/24)和92%(22/24),但不能准确区分其类型。3例浆液性囊腺瘤未行手术治疗;21例手术者中,行胰十二指肠切除术9例,远端胰腺切除术8例,胰腺节段切除术1例,肿瘤摘除术3例,胰瘘是主要的并发症。本组患者均获随访,3例未手术者肿瘤无增大,1例囊腺癌因复发转移于术后11个月死亡,其余均健在,术后无复发。结论B超和CT是胰腺囊性肿瘤主要的影像学检查方法。黏液性囊性肿瘤以及伴有症状的浆液性囊腺瘤需手术治疗。胰腺囊腺瘤手术切除后可获治愈,囊腺癌术后疗效也较满意。     

Cystic pancreatic tumors

Cystic tumors of the Pancreas (CTP) are rare (less than 5% of all pancreatic tumors). We have limited our study to CTP of epithelial origin which represent 90% of all CTP. These can be divided into three subgroups: (1) Benign tumors with no risk of malignant progression (serous cystadenoma). (2) Tumors with risk of malignant degeneration (mucinous cystadenoma, intraductal papillary mucinous tumors (IPMT), and pancreatic solid-cystic papillary tumor. (3) Malignant tumors (cystadenocarcinoma, IPMT with malignant degeneration). The latter two groups of CTP require radical resection while serous cystadenoma does not require surgical intervention unless symptomatic. The ability to determine preoperatively the exact nature of a CTP is of tremendous importance; cytologic examination and biochemical assays of cyst fluid aid greatly in this determination. Better understanding of the biologic evolution of CTP has increased the indications for surgical resection but the risks of postoperative morbidity and mortality in these patients must not be underestimated.     

Cystic pancreas neoplasias

For the treatment of cystic changes of the pancreas, it is essential to distinguish cysts and pseudocysts from neoplasm. Since clinical parameters are usually not characteristic, only morphologic analysis will prove a diagnosis. Nowadays, the cystic pancreatic neoplasms are described as: microcystic adenoma (rich-in-glycogene cystadenoma), and mucinous cystic neoplasms (cystadenocarcinoma or cystadenoma). Morphology, etiology, clinical findings, and treatment are discussed on 3 cases. The new classification of cystic pancreatic neoplasms is important for prognosis in two aspects: 1) On the clinical finding of a pseudocyst, every surgeon should think of a mucinous cystic neoplasm and look for solid tumours digitally. 2) For the pathologist, any mucinous neoplasm should cause him to analyse such cysts macroscopically and, if possible, also microscopically, to rule out an adenocarcinoma.     

Cystic neoplasms of the pancreas – cystadenomas and cystadenocarcinomas

Introduction: Among the rare cystic pancreatic tumors, serous and mucinous cystadenoma and mucinous cystadenocarcinoma are most often diagnosed. Case: We report on a total of 21 patients with cystic neoplasms who underwent surgery, 11 of whom had mucinous cystadenocarcinoma. Of the 10 remaining patients, serous and mucinous cystadenoma were diagnosed in two groups of five. A common feature of all cystic neoplasms is slow growth, leading to clinical symptoms at an advanced stage, with tumors frequently becoming enormous. Results: In approximately half of the cases, diagnosis was possible by means of ultrasound, computed tomography and, in three instances, by preoperative percutaneous aspiration. Differential diagnosis of pseudocysts proved to be most difficult. Conclusion: Given the low operative risk, resection should always be performed in instances where findings cannot be clearly identified. Moreover, compared with ductal pancreatic carcinomas, the prognosis of a cystadenocarcinoma after early resection is extremely favorable, so that postponing resection might reduce the patient's prospects of being cured. Received: 24 April 1998 Accepted: 13 October 1998     

原发性肝内胆管囊性肿瘤

原发性肝内胆管囊性肿瘤（ＰＣＴＩＨＢＤ）比较罕见可分为囊腺瘤和囊腺癌。它们分泌大量的粘液形成单房和多房性囊肿，囊内壁发出乳头状赘生物突入囊腔，囊腺癌通常被认为由囊腺瘤恶变而来。文章报告ＰＣＴＩＨＢＤ５例，其中囊腺癌４例，囊腺瘤１例。５例经Ｂ超和ＣＴ检查后均诊断为肝癌，只是在剖腹探查和病理学检查后才获得正确的诊断，手术切除为唯一有效的治疗。４例囊腺癌中１例术后第６天死于大出血，１例随访７个月后死于肝内复发；另２例分别随访４年及５年均存活。１例囊腺瘤手术７年仍健在。     

胰腺囊性肿瘤的诊治分析

目的 探讨胰腺囊性肿瘤的合理手术方式及术后并发症的处理.方法 对1997年1月至2009年12月收治的32例胰腺囊性肿瘤患者的临床资料进行回顾性分析,男性6例,女性26例,年龄24～76岁.胰腺浆液性囊腺瘤16例;胰腺黏液性囊腺瘤9例,其中1例为黏液性囊腺癌;胰腺导管内乳头状黏液性肿瘤4例;胰腺实性假乳头状瘤3例.肿瘤位于胰头颈部12例,位于胰体尾部20例.结果 所有患者均经手术治疗,无围手术期死亡;10例行胰十二指肠切除术、1例行保留十二指肠胰头切除术、13例行胰体尾切除术(其中2例行腹腔镜下胰体尾切除术)、3例行胰腺肿瘤摘除术、4例行胰腺中段切除术;1例囊腺癌患者仅行姑息手术.术后发生胃瘫3例、胰瘘5例,均经保守治疗痊愈.全组29例患者获得随访,随访时间4个月～10年,3例患者于术后4～34个月分别死于癌转移或其他疾病,其余26例患者均存活,且未发现肿瘤复发或转移.结论 胰腺囊性肿瘤术前应首选无创的CT检查,及时手术探查是防止肿瘤癌变的重要手段;具体的手术方式选择应按个体化原则,并应遵循损伤控制性手术原则;保留器官的手术方式更要重视术后胃瘫、胰瘘等并发症的处理.     

肝胆管囊腺瘤及囊腺癌的CT、MRI诊断

目的总结肝胆管囊腺瘤和囊腺癌的CT、MRI表现,探讨CT、MRI诊断该肿瘤的价值。方法回顾性分析经手术病理证实为肝胆管囊腺瘤(3例)和囊腺癌(5例)的CT和(或)MRI表现、术前诊断,并与病理所见进行对照分析。结果3例囊腺瘤均为单房或多房的囊性肿物,无壁结节,术前均误诊为肝包虫或肝囊肿;5例恶性者中囊腺癌3例,囊腺瘤伴局部癌变2例。5例均为单房或多房的囊实性肿物,有壁结节。CT扫描囊性部分呈均匀液性密度,囊壁、分隔厚薄不均,壁结节大小不一,增强扫描囊壁、分隔及壁结节强化。MR示囊性部分呈均匀液性信号,增强扫描囊壁、分隔及壁结节强化。5例恶性者术前4例诊断为囊腺瘤或囊腺癌,1例诊为胆管癌。CT、MRI表现与病理所见对应良好。结论胆管囊腺癌在CT、MRI上具有特征性表现,可以做到术前正确诊断;但胆管囊腺瘤如果无壁结节则缺乏特征性表现,需要和肝复杂性囊肿或肝包虫病等鉴别。     

胰腺囊性肿瘤的诊治98例报告

目的探讨胰腺囊性肿瘤的常见类型、诊断及合理手术方式的选择。方法对2000年1月至2008年12月期间收治98例胰腺囊性肿瘤患者的临床资料进行回顾性分析。结果本病无特征性的临床表现,B超、CT和Mill等影像学检查也能发现胰腺囊肿病灶但不能确定具体类型。本组胰腺囊腺瘤57例（浆液性囊腺瘤32例,黏液性囊腺瘤25例）,黏液性囊腺癌13例,实性假乳头状瘤19例,导管内乳头状黏液性肿瘤9例。所有患者均手术治疗,胰十二指肠切除26例,保留十二指肠胰头切除28例,胰腺节段切除术7例,胰体尾切除加脾脏切除25例,肿瘤摘除术12例。术后均进行随访,3例胰腺囊腺癌患者于术后6个月到4年期间死于癌转移或其他疾病,1例囊腺癌患者术后9个月肿瘤复发,再次手术后现仍生存,其他均存活。结论B超,CT和MRI等影像学技术是胰腺囊性肿瘤的主要诊断方法。手术切除为治疗该肿瘤的最有效手段。正确的诊断和合理手术方式的选择是提高其临床治愈率的关键。     

Mucobilia in Association With a Biliary Cystadenocarcinoma of the Caudate Duct: A Rare Cause of Malignant Biliary Obstruction

Mucobilia is a rare condition characterized by the accumulation of abundant mucus within the intra- or extrahepatic biliary tree. A variety of hepatobiliary and pancreatic neoplasms are mucin producing and have been associated with the development of mucobilia including biliary mucinosis, biliary papillomatosis, mucin-producing cholangiocarcinoma (MPCC), or cystic neoplasms of the pancreas or biliary tree (cystadenoma or cystadenocarcinoma). We report the case of 46 year-old male with a biliary cystadenocarcinoma of the caudate lobe which resulted in chronic biliary obstruction and relapsing cholangitis. A review of the literature for both mucobilia and biliary cystadenocarcinoma is provided along with a discussion addressing the clinical presentation, diagnosis, treatment, and prognosis for this rare entity.     

胰腺真性囊肿的诊断和治疗(附13例报告)

胰腺真性囊肿较少见，为提高其临床诊治水平，作者回顾性分析了该院4年内手术治疗的13例胰腺真性囊肿的临床病理特点和手术方法，其中潴留性囊肿6例，囊腺瘤4例，囊腺瘤癌变2例，高分化囊腺癌1例。结果显示：该病的临床表现无特异性，B超和CT检查具有肯定的定位诊断价值，但难于定性诊断；囊肿以多房和／或多发性多见。潴留性囊肿囊液多为浆液性，囊壁细胞多为扁平上皮；囊腺瘤囊液多为粘液性，囊壁细胞多为立方和／或柱状上皮。柱状上皮具有癌变倾向。手术宜行包括囊肿在内的切除术，而不宜做内或外引流术。     

Pathologic examination accurately predicts prognosis in mucinous cystic neoplasms of the pancreas.

The behavior of pancreatic mucinous cystic neoplasms has long been debated. Some authors contend that histologically benign neoplasms can recur and metastasize. We reviewed the gross and microscopic findings and outcomes of 61 mucinous cystic neoplasms diagnosed at The Johns Hopkins Hospital from March 20, 1984 to July 8, 1998. Each neoplasm was placed into one of four categories based on complete histologic examination: invasive mucinous cystadenocarcinoma, mucinous cystic neoplasm with in situ carcinoma, borderline mucinous cystic neoplasm, and mucinous cystadenoma. Neoplasms in the latter three categories were included only if they were entirely resected and completely examined. Patient outcomes were obtained from hospital records and patient and physician follow-up. Twenty (33%) of the patients had invasive mucinous cystadenocarcinomas, and they had 2- and 5-year disease-specific survival rates of 67% and 33% (mean follow-up of survivors, 4.2 years), respectively. Nine (15%) patients had mucinous cystic neoplasms with in situ carcinoma (mean follow-up of survivors, 4.1 years). Five (8.2%) patients had borderline mucinous cystic neoplasms (mean follow-up of survivors, 5.6 years). Twenty-seven (44%) patients had mucinous cystadenomas (mean follow-up of survivors, 5.1 years). No mucinous cystadenoma, borderline mucinous cystic neoplasm, or mucinous cystic neoplasm with in situ carcinoma recurred or metastasized. No patient with the diagnosis of mucinous cystadenoma, borderline mucinous cystic neoplasm, or mucinous cystic neoplasm with in situ carcinoma died of disease. The difference in disease-specific survival rates between patients with invasive mucinous cystadenocarcinomas and those with noninvasive tumors was significant (p < 0.0001, log-rank test). One case, originally showing only benign histology on incisional biopsy, contained foci of invasive carcinoma on complete resection. Completely resected and entirely examined mucinous cystadenomas, borderline mucinous cystic neoplasms, and mucinous cystic neoplasms with in situ carcinoma follow benign courses. Because invasive carcinoma can be focal, failure to study an entire mucinous cystic neoplasm may result in the miscategorization of a malignant neoplasm as benign.     

Cystic tumours of the pancreas: diagnostic accuracy, pathologic observations and surgical consequences

Background: Cystic neoplasms of the pancreas account for only 1% of primary pancreatic lesions. However, patients with these tumors are diagnosed more frequently. Up to now, nonsurgical management is still the established form of treatment of benign cystic tumours of the pancreas. Methods: Between 1987 and 1996 we treated 51 patients with serous and mucinous cystadenoma and their malignant counterparts, serous and mucinous cystadenocarcinoma. Results: Eighty-five percent of the patients presented symptoms. Computed tomography and endoscopic cholangiopancreatography (ERCP) were the most sensitive diagnostic techniques; however, in three patients with serous cystadenoma and in one patient with serous cystadenocarcinoma, ERCP findings were completely normal. The tumour was resected in all but one patient. There was no perioperative mortality. After dismissal from the hospital, all patients in whom benign tumours had been resected are still alive; however, the late mortality of mucinous cystadenocarcinoma was 36% after a median follow-up of 6 years. Conclusion: Surgical resection is recommended in all cystic tumours, even in serous cystic tumours, because symptoms may develop and malignant transformation to serous cystadenocarcinoma is possible. Received: 6 November 1997     

胰腺囊性肿瘤40例诊疗分析

目的探讨胰腺囊性肿瘤的诊治方法。方法对笔者所在医院科室2001年10月至2013年10月期间收治的40例胰腺囊性肿瘤患者的临床资料进行回顾性分析。结果胰腺囊性肿瘤无特殊临床表现,B超和CT检查对胰腺囊性肿瘤的诊断正确率分别为57．5％（23／40）和72．5％（29／40）,但不能准确区分其组织学类型。40例患者均行手术治疗,其中2例患者误诊为假性囊肿而行内引流术,另外38例行胰体尾切除术。术后病理学检查证实浆液性囊腺瘤23例,黏液性囊腺瘤9例,导管内乳头状黏液性腺瘤3例,黏液性囊腺癌5例。5例失访,35例患者获随访,随访时间为（74．2±12．8）个月（2个月～8年）;3例囊腺癌患者中1例肿瘤切除者至今存活（已随访8年）,2例肿瘤未切除者分别于术后4个月和7个月因肿瘤转移死亡;其余32例获访的囊腺瘤患者均存活至今。结论外科切除是治疗胰腺囊性肿瘤最有效的手段,即使是对于无任何症状的患者也应行积极的手术治疗。     

肝内胆管囊腺瘤与囊腺癌的诊断及外科治疗

目的 探讨肝内胆管囊腺瘤和囊腺癌的诊断和治疗方法.方法 对中国医学科学院肿瘤医院1996年1月至2007年10月收治的8例肝内胆管囊腺瘤和囊腺癌的临床资料进行回顾性分析.结果 肝内胆管囊腺瘤和囊腺癌无特征性临床表现.术前AFP均为阴性;B超和CT的诊断正确率分别为75%(6/8)、87.5%(7/8).8例病人均行手术切除,7例行肝肿瘤不规则切除术,1例行左半肝切除术.术后病人恢复良好.8例均获得随访,除1例囊腺癌术后3年死于肿瘤复发转移外,其余均生存良好.结论 肝内胆管囊腺瘤与囊腺癌主要依靠影像学和病理诊断,手术切除可以获得满意的疗效.     

保留十二指肠胰头切除术的适应证及术式选择:附22例报告

目的探讨保留十二指肠胰头切除术（DPPHR）的适应证及具体术式的选择指征。方法回顾性分析我中心2001年1月至2006年1月实施的22例DPPHR术患者的临床资料,其中黏液性囊腺瘤8例,黏液性囊腺癌2例,实性-假乳头状瘤4例,神经内分泌肿瘤2例,慢性胰腺炎4例（伴胰头肿块2例,伴多发结石2例）,淋巴上皮囊肿1例,浆液性囊腺瘤1例。探讨DPPHR术式的适应证、手术方式的选择及术后并发症的防治。结果患者手术死亡0例,术后发生胰瘘3例,胆瘘1例,腹腔感染1例,十二指肠瘘2例。结论DPPHR术保留了胃、十二指肠及胆道的连续性,手术安全性好,降低了手术创伤和切除范围,可作为胰头颈部良性和低度恶性肿块局限性切除的术式。     

Metastases from carcinomas of the pancreas simulating primary mucinous tumors of the ovary. A report of seven cases

We report seven patients with mucinous tumors of the ovary that we interpreted as metastases from adenocarcinomas of the exocrine pancreas. The ovarian metastases closely resembled primary mucinous tumors of the ovary. The patients' ages ranged from 29 to 87 years (average, 63 years). The ovarian and pancreatic tumors were discovered synchronously in five patients. In two patients, the pancreatic tumor preceded the ovarian tumor by 9 months and 8.5 years, respectively. In four patients, the clinical presentation simulated primary ovarian cancer. The ovarian tumors were typically large, multiloculated cystic neoplasms. Six of them were bilateral; the status of the opposite ovary is not known in one case. Microscopically, they manifested varying degrees of differentiation, usually containing foci resembling mucinous cystadenoma, mucinous tumor of borderline malignancy, and well-differentiated mucinous cystadenocarcinoma. The primary pancreatic tumors were typical ductal adenocarcinomas in six patients and mucinous cystadenocarcinoma in the seventh. Features pointing toward the metastatic nature of the ovarian tumors included bilaterality, surface desmoplastic implants, and extraovarian spread. The possibility of metastases should be strongly considered whenever evaluating mucinous ovarian tumors, especially those that are bilateral or have other unusual features. The pancreas is an important source of metastatic tumors that simulate primary ovarian mucinous cystadenocarcinomas and borderline tumors.