胰腺囊性肿瘤26例临床诊治分析

目的探讨胰腺囊性肿瘤的诊断和治疗。方法对2000年6月至2005年6月复旦大学附属中山医院收治的26例胰腺囊性肿瘤的临床资料进行回顾性分析。结果B超和CT对胰腺囊性肿瘤的诊断正确率分别为88%(23/26)和92%(24/26),但不能准确区分其组织类型。26例均行手术治疗并获随访,1例黏液性囊腺癌病人因复发转移于术后11个月死亡,其余均存活,无复发。结论伴有症状的胰腺浆液性囊腺瘤,以及黏液性囊性肿瘤及导管内乳头状黏液性肿瘤因有恶变倾向及临床不能鉴别其良恶性,需手术治疗;而无症状的浆液性囊腺瘤可观察随访。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。     

胰腺囊性肿瘤诊治进展

目的：探讨胰腺囊性肿瘤的影像学特点和诊治方法,方法：参考目前关于胰腺囊性肿瘤的最新研究成果。结果：探讨了胰腺囊性肿瘤与胰腺假性囊肿的鉴别诊断,分别就浆液性囊性肿瘤（SCN）、粘液性囊性肿瘤(MCN)、导管内乳头状瘤(IPMN)和实性假乳头状瘤（SPN）的影像学特点和治疗方法进行了讨论,并且就内镜超声（EUS）、内镜超声引导下穿刺抽吸活检（EUS-FNA）以及囊液分析的诊断价值进行了深入探讨。结论：结论：尽管囊性病变有典型的影像学表现,但单一的影像检查的准确性还是有限的,CT、MR应与EUS相辅相成,而且还可行囊肿穿刺,分析囊液的成分,对于诊断不明确的病例,可以通过动态的影像检查来观察。     

胰腺囊性肿瘤术前良恶性判断

随着影像诊断技术的广泛应用和改进,胰腺囊性肿瘤（PCN）的诊断率不断增加。常见的胰腺囊性肿瘤包括浆液性囊腺瘤（SCN）、黏液性囊腺瘤（MCN）和导管内乳头状黏液性肿瘤（IPMN）以及囊实性假乳头状肿瘤（SPN）,一旦怀疑为恶性时,均应行根治性手术切除。PCN的术前诊断和良恶性判断十分重要,目前主要依靠临床表现、影像学检查和实验室检查。当临床发现老年男性病人、血清肿瘤标记物CA19-9升高、伴有巨大胰腺肿块、体重下降、有特征性影像学表现者,应考虑恶性肿瘤的可能。主要依靠术后病理、经超声内镜下囊液抽取分析和穿刺组织活检确诊,包括肿瘤相关DNA、MicroRNA和蛋白质标记物的分析。     

胰腺实性假乳头状瘤47例临床诊治分析

目的探讨胰腺实性假乳头状瘤（solid pseudopapillary tumor,SPT）的临床病理特征与诊断、治疗及预后。方法对2006年1月～2011年12月我院47例SPT的临床表现、实验室和影像学检查、病理结果、治疗和预后进行回顾性分析。结果 45例行手术切除,其中胰十二指肠切除术11例、胰体尾＋脾切除术18例、胰尾切除术2例、胰腺中段切除术3例、肿瘤局部切除术9例、术后复发再次手术2例;开腹探查术2例。术后出现胰漏14例,胆漏2例,出血3例,腹腔感染3例,胃瘫4例。45例术后随访3～68个月,平均32个月,其中随访〉24个月29例,均未出现复发和转移,无死亡。结论胰腺SPT是一种低度恶性肿瘤,临床表现无特异性,CT及MRI是最主要的影像学检查方法,治疗以手术切除为主,预后良好。     

胰腺导管内乳头状黏液性肿瘤的诊治策略

胰腺导管内乳头状黏液性肿瘤（intraductal papillary mucinous neoplasm,IPMN）分主胰管型、混合型和分支胰管型。主胰管型、混合型和有症状的分支胰管型IPMN建议行手术切除,对恶性IPMN,需行规则性胰腺切除。对良性和交界性IPMN,可行功能保留性胰腺手术。对暂时不行手术切除的IPMN病人,应定期随访。IPMN的治疗决策需综合考虑各方面因素,包括病人的预期寿命、身体状况、治疗意愿、依从性、随访的条件等加以综合评估,最后形成个体化的治疗方案。     

胰腺导管内乳头状黏液性肿瘤27例诊治分析

目的总结胰腺导管内乳头状黏液性肿瘤(IPMN)的诊治经验,寻找术前预测浸润性IPMN的指标.方法将2003年9月-2010年7月手术治疗的27例胰腺IPMN病例分为浸润性与非浸润性IPMN两组,分析比较两组间术前资料的差异.结果浸润性IPMN 15例,非浸润性IPMN12例.两组间术前梗阻性黄疸发病率、肿瘤最大直径、血...     

58例胰腺导管内乳头状黏液性肿瘤临床分析

目的探讨胰腺导管内乳头状黏液性肿瘤(intraducta[papillary mucinous neoplasm,IPMN)的诊断和治疗。方法回顾性分析2004年12月至2014年12月10年间收治58例IPMNs病人的临床资料、病理分型、治疗方式。男性36例,女性22例,男女比例为1.6:1,年龄39~82岁,中位年龄67岁。58例IPMNs病人均行手术治疗。其中行胰十二指肠切除术31例(53.45%),胰头部局部切除术9例(15.52%),胰体尾切除术7例(12.07%),胰体部局部切除术4例(6.90%),胰尾切除术4例(6.90%),胰尾联合脾切除1例(1.72%),全胰腺切除2例(3.44%)。结果58例IPMNs病人中主胰管型26例;分支胰管型9例;混合型23例;术后病理:腺瘤26例,交界瘤13例,非浸润癌10例,浸润性癌9例;全组的中位生存期为42.6个月;1、2和5年的生存率分别为94.5%、79.3%和65.5%。其中病理类型为浸润性癌的病人1、2、5年生存率分别为62.5%、47.5%、12.5%。结论IPMN是一种比较罕见的肿瘤,手术治疗是目前比较好的治疗方式。     

胰腺导管内乳头状黏液性肿瘤13例临床分析

目的总结胰腺导管内乳头状黏液性肿瘤(IPMT)的诊治经验,提高对该病治疗水平。方法自1985年5月至2004年3月共收治IPMT病人13例,男8例,女5例。所有病人均有不同程度的胰管扩张,8例进行了ERCP检查,发现胰管扩张,胰液溢出5例。结果除1人外,其他病人均接受了手术治疗,手术效果良好。术后病理诊断为胰头导管乳头状黏液性腺癌3例;胰头导管内乳头状黏液性腺瘤伴局部癌变2例;胰头导管内乳头状黏液性腺瘤伴不典型增生2例;胰头导管内乳头状黏液性腺瘤5例。结论IPMT与胰腺导管癌不同,ERCP有助于诊断本病,积极的手术治疗可获得良好的预后。     

Risk of Malignancy in Resected Cystic Tumors of the Pancreas ≤3 cm in Size: Is it Safe to Observe Asymptomatic Patients? A Multi-institutional Report

Recent international consensus guidelines propose that cystic pancreatic tumors less than 3 cm in size in asymptomatic patients with no radiographic features concerning for malignancy are safe to observe; however, there is little published data to support this recommendation. The purpose of this study was to determine the prevalence of malignancy in this group of patients using pancreatic resection databases from five high-volume pancreatic centers to assess the appropriateness of these guidelines. All pancreatic resections performed for cystic neoplasms ≤3 cm in size were evaluated over the time period of 1998–2006. One hundred sixty-six cases were identified, and the clinical, radiographic, and pathological data were reviewed. The correlation with age, gender, and symptoms (abdominal pain, nausea and vomiting, jaundice, presence of pancreatitis, unexplained weight loss, and anorexia), radiographic features suggestive of malignancy by either computed tomography, magnetic resonance imaging, or endoscopic ultrasound (presence of solid component, lymphadenopathy, or dilated main pancreatic duct or common bile duct), and the presence of malignancy was assessed using univariate and multivariate analysis. Among the 166 pancreatic resections for cystic pancreatic tumors ≤3 cm, 135 cases were benign [38 serous cystadenomas, 35 mucinous cystic neoplasms, 60 intraductal papillary mucinous neoplasms (IPMN), 1 cystic papillary tumor, and 1 cystic islet cell tumor], whereas 31 cases were malignant (14 mucinous cystic adenocarcinomas and 13 invasive carcinomas and 4 in situ carcinomas arising in the setting of IPMN). A greater incidence of cystic neoplasms was seen in female patients (99/166, 60%). Gender was a predictor of malignant pathology, with male patients having a higher incidence of malignancy (19/67, 28%) compared to female patients (12/99, 12%; p < 0.02). Older age was associated with malignancy (mean age 67 years in patients with malignant disease vs 62 years in patients with benign lesions (p < 0.05). A majority of the patients with malignancy were symptomatic (28/31, 90%). Symptoms that correlated with malignancy included jaundice (p < 0.001), weight loss (p < 0.003), and anorexia (p < 0.05). Radiographic features that correlated with malignancy were presence of a solid component (p < 0.0001), main pancreatic duct dilation (p = 0.002), common bile duct dilation (p < 0.001), and lymphadenopathy (p < 0.002). Twenty-seven of 31(87%) patients with malignant lesions had at least one radiographic feature concerning for malignancy. Forty-five patients (27%) were identified as having asymptomatic cystic neoplasms. All but three (6.6%) of the patients in this group had benign disease. Of the patients that had no symptoms and no radiographic features, 1 out of 30 (3.3%) had malignancy (carcinoma in situ arising in a side branch IPMN). Malignancy in cystic neoplasms ≤3 cm in size was associated with older age, male gender, presence of symptoms (jaundice, weight loss, and anorexia), and presence of concerning radiographic features (solid component, main pancreatic duct dilation, common bile duct dilation, and lymphadenopathy). Among asymptomatic patients that displayed no discernable radiographic features suggestive of malignancy who underwent resection, the incidence of occult malignancy was 3.3%. This study suggests that a group of patients with small cystic pancreatic neoplasms who have low risk of malignancy can be identified, and selective resection of these lesions may be appropriate.     

Cystic lesions of the pancreas: an appraisal of an aggressive resectional policy adopted at a single institution during 15 years

BACKGROUND: Although an aggressive resectional approach toward pancreatic cysts has been advocated in the past, many clinicians now deem this therapeutic strategy impractical given the rapidly increasing incidence of incidentally detected pancreatic cystic lesions. The aim of this study was to review the aggressive resectional policy toward pancreatic cysts adopted at our institution during the past 15 years. METHODS: One hundred nine consecutive patients who underwent surgical resection of a cystic lesion of the pancreas during a 15-year period were retrospectively reviewed. To determine subsets of patients at lower risk of having a malignant cyst, the clinicopathologic features (in particular, the malignant potential) of these patients were compared as a function of 3 variables, ie, presence of symptoms, patient age, and cyst size, using univariate analyses. Results were expressed as median and range and P < .05 was considered statistically significant. RESULTS: Forty-three (39%) of 109 patients were asymptomatic. Incidental cysts were smaller (28 [10 to 240] vs 59 [10 to 200] mm, P < .001) and were found in older patients (55.0 [18 to 77] vs 45.5 [14 to 82] years, P = .003). Overall, 14% of asymptomatic cysts, versus 35% of symptomatic cysts, were malignant (P = .016). Incidental cysts were also less likely to be premalignant or malignant compared with symptomatic cysts (47% vs 70%, P = .015). Twenty (18%) patients were elderly (73.0 [70 to 82] years old). Elderly patients had a more equal sex distribution (45% vs 76% female, P = .005) and had smaller cysts (26 [10 to 200] vs 55 [10 to 240] mm, P = .003) that involved the head of the pancreas more frequently (8 [40%] vs 17 [19%], P = .045) compared with their younger counterparts. The cohort of elderly patients also had a higher median American Society of Anesthesiologists score (2 [1 to 3] vs 1 [1 to 3], P < .001), and a higher proportion had undergone a "more" major procedure (Whipple's or total pancreatectomy) (55% vs 18%, P < .001). Not unexpectedly, surgical morbidity in the elderly was significantly higher (10 [50%] vs 24 [27%], P = .045). The operative mortality in both groups was not significantly different (1 [5%] vs 1 [1%], P = .324). The proportion of premalignant or malignant lesions in elderly patients was also similar to that in younger patients (11 [55%] vs 55 [62%], P = .574). The size of a cyst in asymptomatic patients had no correlation with its potential for malignancy. CONCLUSIONS: Reliance on preoperative characteristics alone such as the presence of symptoms, cyst size, and patient age are not sufficiently reliable in determining the malignant potential and thus management approach toward pancreatic cysts.     

Analysis of Pancreatic Cyst Fluid

Pancreatic cysts are extremely common, and are identified in between 2% to 13% on abdominal imaging studies. Most pancreatic cysts are pseudocysts, serous cystic neoplasms, mucinous cystic neoplasms, or intraductal papillary mucinous neoplasms. The management of pancreatic cysts depends on whether a cyst is benign, has malignant potential, or harbors high-grade dysplasia or invasive carcinoma. The diagnosis of pancreatic cysts, and assessment of risk of malignant transformation, incorporates clinical history, computed tomography (CT), magnetic resonance imaging (MRI), endoscopic ultrasound, and fine-needle aspiration of cyst fluid. This article reviews the cyst fluid markers that are currently used, as well as promising markers under development.     

胰腺囊性肿瘤的诊断和外科治疗

目的：探讨胰腺囊性肿瘤的诊断和外科治疗方法。方法：对28例胰腺囊性肿瘤病人的临床资料进行回顾性分析。结果：胰腺囊性肿瘤多无特征性临床表现,影像学检查及确诊率：B超71.4%、CT82.1%和MRI80%。全组手术切除率89.3%。手术后发生胰瘘12例和腹腔感染4例,2例（黏液性囊腺癌和导管内乳头状黏液腺癌各1例）术后2年内死亡。结论：胰腺B超和CT检查是早期发现胰腺囊性肿瘤的最有效方法,积极手术治疗,多数患者可获得较好治疗效果。     

Mucinous Cystic Neoplasms

Mucinous cystic neoplasms of the pancreas are uncommon tumors of the pancreas that occur predominantly in middle-aged women and almost exclusively in the body and tail of the pancreas. They are lined by a mucinous epithelium that can exhibit varying grades of dysplasia and are surrounded by a characteristic ovarian-like stroma. Surgery is the treatment of choice, and prognosis is excellent in the absence of invasive carcinoma. This paper was originally presented as part of the SSAT/AGA/ASGE State-of-the-Art Conference on Management of Cystic Lesions of the Pancreas at the SSAT 48th Annual Meeting, May 2007, in Washington, DC. The other articles presented in the conference were Adsay NV, “Cystic Neoplasia of the Pancreas: Pathology and Biology”; Scheiman JM, “Management of Cystic Lesions of the Pancreas: Diagnosis: Radiographic Imaging, EUS and Fluid Analysis”; Tseng JF, “Management of Serous Cystadenoma of the Pancreas”; and Farnell MB, “Surgical Management of Intraductal Papillary Mucinous Neoplasm (IPMN) of the Pancreas.”     

Molecular Diagnostics in the Evaluation of Pancreatic Cysts

Within the past few decades, there has been a dramatic increase in the detection of incidental pancreatic cysts. It is reported a pancreatic cyst is identified in up to 2.6% of abdominal scans. Many of these cysts, including serous cystadenomas and pseudocysts, are benign and can be monitored clinically. In contrast, mucinous cysts, which include intraductal papillary mucinous neoplasms and mucinous cystic neoplasms, have the potential to progress to pancreatic adenocarcinoma. In this review, we discuss the current management guidelines for pancreatic cysts, their underlying genetics, and the integration of molecular testing in cyst classification and prognostication.     

胰腺囊性肿瘤的临床诊治

提高对胰腺囊性肿瘤诊断和治疗的认识,减少这种少见肿瘤的误诊误治。方法:对1958年4月～1995年7月经病理证实的15例胰腺囊性肿瘤病人进行回顾性分析。结果:15例胰腺囊性肿瘤中,浆液性囊腺瘤6例,粘液性囊性肿瘤9例。肿瘤位于胰头部4例,体尾部10例,全胰1例。15例病人全部进行手术治疗,其中12例获手术切除,切除率为80％。术前明确诊断为胰腺囊性肿瘤者仅6例,其余9例术前被误诊为胰腺假性囊肿或中、上腹肿块而行手术,其中7例术中被诊为囊性肿瘤而获相应的根治性切除,另2例被错误地进行了内引流术。结论:胰腺囊性肿瘤临床上常被误诊,只要综合运用病史分析、影像学特点、囊液分析、术中活检等方法,就能提高诊断的准确率。胰腺囊性肿瘤手术切除率高,预后较好。