超声内镜对胰腺囊性肿瘤的诊断与治疗的应用进展

随着对胰腺囊性肿瘤认识的提高及影像学诊断仪器的普及,该病的检出率显著提高。由于胰腺囊性肿瘤种类繁多,病理分级可为良性、低度恶性及恶性,而且随着肿瘤体积的增大,病理分级也会不断改变。良性病变的准确诊断对于确定手术方式或内镜治疗的监测需求,以及避免对无潜在恶性的囊肿进行不必要的手术显得尤为重要。近年来,超声内镜(EUS)在胰腺囊性肿瘤的诊断及治疗方面取得了很大进展,本文综述了超声内镜对胰腺囊性肿瘤的诊断与治疗进展。     

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。     

胰腺囊性肿瘤的诊断与治疗

胰腺囊性肿瘤（cystic tumors of the pancreas）是较少见的肿瘤,术前常难于确诊,常见的几种肿瘤为胰腺囊腺瘤和囊腺癌、胰腺实性假乳头肿瘤和胰腺导管内乳头状黏液性肿瘤。胰腺囊性肿瘤发病率以黏液性囊腺瘤或囊腺癌最高,浆液性囊腺瘤次之。近年来,胰腺实性假乳头状瘤（或称囊实性肿瘤）和导管内乳头状黏液瘤的文献报道增多。熟悉这几种肿瘤的临床特点,特别是影像学特征,能提高诊断准确率,确定正确的治疗方案,从而提高治疗效果。     

微创外科时代胰腺囊性肿瘤的诊断和治疗

胰腺囊性肿瘤占胰腺囊性疾病的10%～15%,随着影像诊断技术的普及和医疗水平的发展,其检出率不断增加。它多为良性或低度恶性肿瘤,存在恶变可能,需要手术切除,且适合微创手术。当然,胰腺手术并发症率高,仍然是高风险手术,其早期精确的诊断对决定合理的治疗至关重要。对于大多数胰腺囊性肿瘤,胰腺增强CT,必要时结合MRCP或MRI,足以做出诊断。超声内镜检查+穿刺抽液有助于确定诊断和手术时机。手术方式的选择取主要取决于囊性肿瘤的性质及位置。     

胰腺囊性肿瘤13例诊治体会

目的 探讨胰腺囊性肿瘤的诊断与治疗方法.方法 对13例胰腺囊性肿瘤患者的临床资料进行回顾性分析.结果 浆液性囊腺瘤4例,黏液性囊腺瘤7例,黏液性囊腺癌2例.B超和CT诊断胰腺囊性肿瘤的正确率分别为85%(11/13)和92%(12/13).采取胰十二指肠切除术6例,胰体尾部切除3例,胰腺局部切除3例,囊壁大部切除1例....     

胰腺囊性肿瘤临床诊治特征分析：附112例报告

目的：探讨胰腺囊性肿瘤临床特点、诊断方式以及治疗结局,为临床诊治提供参考。 方法：回顾性分析2007年9月—2014年9月112例胰腺囊性肿瘤患者的临床资料。 结果：112例患者中,111例（99.1%）胰腺囊性肿瘤单发;确诊时81例（72.32%）患者无明显临床症状;超声、CT、MRI、EUS诊断的准确率分别为86.61%、89.11%、93.88%、93.33%,4种检查方式准确率差异无统计学意义（χ2=1.010,P=0.224）;胰体尾加脾切除术48例（42.86%）,胰十二指肠切除术23例（20.54%）,保留脾脏胰体尾切除13例（11.61%）,Beger术3例（2.68%）,全胰腺切除2例（1.78%）,胰腺中段切除1例（0.89%）,联合脏器切除1例（0.89%）,肿瘤摘除 21例（18.75%）;术后发生胰瘘18例（16.07%）,其中胰十二指肠切除术后胰瘘发生7例（30.43%,7/23）,胰体尾加脾切除胰瘘发生9例（18.75%,9/48）,保留脾脏胰体尾切除术后胰瘘发生2例（15.38%,2/13）,胰十二指肠切除术后胰瘘发生率明显高于其他两种术式（χ2=4.767,P=0.010;χ2=5.854,P=0.007）;76例（67.86%）病理结果良性,36例（32.14%）病理结果恶性。良性患者5年生存率为100%,恶性患者1、3、5年生存率分别为86.96%、52.17%、26.08%。 结论：胰腺囊性肿瘤多数患者无明显临床症状,单发胰体尾部胰腺肿瘤占多数,影像学诊断准确率较高,良性胰腺囊性肿瘤预后好,恶性胰腺囊性肿瘤应积极实施根治手术。     

胰腺囊性肿瘤的诊断与治疗进展

胰腺囊性肿瘤（cystic tumors of the pancreas）是指一类胰管或腺泡组织上皮细胞增生致使分泌物潴留而发生的肿瘤性囊性病变，是一种少见的肿瘤，国内文献报道较少，极易造成误诊、误治。常见的胰腺囊性肿瘤为胰腺囊腺瘤和囊腺癌、胰腺实性假乳头肿瘤和胰腺导管内乳头状黏液性肿瘤。现将上述几种胰腺肿瘤的临床特点分述如下，以提高术前和术中的诊断准确率，确定正确的治疗方案，提高治疗效果。     

胰腺囊性肿瘤的临床诊治

目的：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     

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。     

重视胰腺囊性肿瘤的定性诊断

胰腺囊性肿瘤在胰腺肿瘤中仅占少数。国内对其发病率报道甚少。多数临床医师对其临床病理特征缺乏深入的研究，亦缺少成功治疗经验，不少病例发生诊断与治疗错误。虽然影像诊断与外科治疗的进步已提高胰腺囊性肿瘤的发现率与定性诊断率，但临床与病理方面对其恶性行为认识上的不足，导致了其预后的不确定性，对胰腺囊性肿瘤亚分类的发病率更是知之甚少。一些来自多中心的临床报道对深入研究与指导治疗具有借鉴意义。     

胰体尾部肿瘤的手术切除

摘要：目的 探讨胰体尾部肿瘤的外科治疗方法。方法 近18年来，采用手术治疗胰体尾部肿瘤45例，其中恶性肿瘤33例，良性肿瘤12例；行远端胰腺切除17例，联合脏器切除24例，肿瘤局部切除4例。结果 病理类型：胰体尾癌33例，胰岛细胞瘤8例，囊腺瘤2例，上皮样纤维瘤1例，囊性畸胎瘤1例。切除肿瘤最大径：胰体尾癌平均为（8.0±2.6）cm；胰岛细胞瘤平均为（6.5±2.4）cm。无手术死亡病例。术后并发症：胰瘘2例，膈下脓肿2例，胰腺假性囊肿1例，上消化道出血 1例，切口感染或愈合不良3例，均经非手术疗法治愈。结论 远端胰腺切除术是治疗胰体尾部肿瘤的有效方法；术前需常规做好联合脏器切除的准备；胰腺残端的处理选用主胰管结扎加褥式缝合法可有效避免胰瘘的发生。     

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。     

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胰腺囊性肿瘤生物学行为多样。手术是治疗胰腺囊腺瘤惟一有效方法。目前,腹腔镜治疗胰腺囊性肿瘤术式包括胰腺囊肿剜除术、腹腔镜下保留脾或不保留脾的胰体尾切除术、腹腔镜胰腺节段切除、胰腺假性囊肿引流术及腹腔镜下胰十二指肠切除术或全胰切除术。腹腔镜治疗胰腺囊性肿瘤具有创伤小、并发症少、术后恢复快等优点,是未来胰腺囊性肿瘤治疗的主要方式。     

Cystic pancreatic neuroendocrine tumors: Is preoperative diagnosis possible?

Pancreatic neuroendocrine tumors rarely undergo cystic degeneration leading to a radiologic appearance, which is often interpreted as a pancreatic mucinous cystadenoma or pseudocyst. We reviewed our experience with 38 neuroendocrine tumors, four of which were cystic, and 24 other cystic pancreatic tumors (mucinous cystadenoma [n = 5], cystadenocarcinoma [n = 6], serous cystadenoma [n = 3], solid/cystic papillary neoplasm [n = 3], intraductal papillary mucinous tumor [n = 6], and mucinous adenocarcinoma [n = 1]) managed operatively between 1990 and 2000. This review was undertaken to identify clinical and pathologic features useful for preoperative diagnosis of cystic neuroendocrine tumors. Two of the four patients with cystic neuroendocrine tumors presented with abdominal pain, one patient was asymptomatic, and one patient had hypoglycemia. Three of the four cystic neuroendocrine tumors were identified by CT scan, and none were biopsied preoperatively. Preoperative diagnoses included mucinous cystadenoma in two patients (n = 2), pancreatic cystic neoplasm in one patient, (n = 1) and insulinoma in one patient (n = 1). All four cystic neuroendocrine tumors were benign and were completely resected (distal pancreatectomy [n = 2], enucleation [n = 2]). Cystic neuroendocrine tumors are difficult to diagnose preoperatively because the majority of these tumors are nonfunctional, and CT does not differentiate these tumors from other cystic neoplasms. Cystic neuroendocrine tumors represent a subgroup of pancreatic cystic and neuroendocrine tumors with malignant potential. Their high resectability rate further supports the role of surgical exploration and resection in the treatment of pancreatic cystic neoplasms. Presented at the Third Americas Hepatopancreatobiliary Congress, Miami, Fla., February 22–25, 2001.     

胰腺素腺瘤和囊腺癌的诊治

目的 探讨胰腺囊性肿瘤的诊断和治疗。方法 对1978-1998年收治的均经手术和病理检查证实为胰腺囊性肿瘤的11例临床资料进行回顾性分析。结果 胰腺囊性肿瘤好发于中青年女性,临床表现为病程较长的上腹部肿物和胀痛。钡餐、B超、CT及ER-CP能协助诊断,本组11例中行胰十二指肠切除2例,胰体尾加脾切除6例,肿瘤单纯切除2例,囊肿-空肠袢式吻合1例,手术切除率为90.9%,术后1例死于腹内感染并峰主血症术后存活的10例均获随访（100%）。1例胰腺囊腺瘤手术后3个月死于心肌梗死,1例胰腺囊腺癌术后4年3个月死于癌转移,其余均健在,结论 凡中青年女性,上腹或左上腹出现较大肿块,且病程较长。结合B超和CT检查可对本病的诊断,胰腺囊腺瘤或囊腺癌,癌体虽较大,均有完整的包膜,而易于分离切除,首选手术方式为包括部分胰腺组织的全肿瘤切除术,疗效满意。     

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 对本院近3年内收治的7例病人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。影像学校查胰腺肿块为囊性，囊实性或不规则分叶状。6例手术治疗，l例拒绝手术。结论 因术前术中定性困难，除假性囊肿或典型的浆液性囊腺瘤外；都应按恶性肿瘤处理。     

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目的　探讨胰腺囊性肿瘤的诊断和治疗。方法　对 1978年以来 19例胰腺囊性肿瘤的临床资料进行回顾性分析。结果　肿瘤位于胰头部 4例 ,胰体尾部 15例。行不同术式的肿瘤切除 13例 ,外引流 1例 ,内引流 2例 ,剖腹探查、肿瘤活检 3例。无手术死亡。随访囊腺瘤 3例 ,分别随访 6个月、16年和 2 1年仍生存 ;囊腺癌 9例 ,生存时间 <6个月 3例 ,6个月至 2年 4例 ,3年 4个月 1例 ,最长 1例 8年仍生存。结论　B超和CT是诊断胰腺囊性肿瘤的有效方法 ,二者结合使用可提高诊断率。该病切除率高 ,预后较好。应首选手术治疗。     

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与外科治疗。方法回顾性研究北京大学第一医院外科1994—2004年所收治45例胰腺囊性肿瘤的临床资料。结果本组病例涉及8种不同囊性肿瘤，男12例，女33例，平均年龄49．1岁，临床表现无特异性。B超及CT检查提示囊性或囊实性占位，ERCP、EUS等可提供鉴别诊断线索。根据肿瘤位置及性状选择局部切除术13例，Whipple术12例，胰体尾切除术18例，全胰腺切除术1例，单纯活检术1例。无围手术期死亡，术后胰瘘2例经保守治疗痊愈。随访38例，平均32．6个月。随访期内死亡4例，其中3例死于肿瘤复发，其余病人无瘤生存。结论胰腺囊性肿瘤包括多种亚型，临床表现均无特异性，诊断须综合各项检查结果，诊断明确者应积极手术治疗，切除率高，预后较好。     

MRI-cholangiopancreatography characteristics of cystic pancreatic tumors

STUDY AIM: The purpose was to assess the value of MR cholangiopancreatography (MRCP) to evaluate the diagnosis and surgical resectability of pancreatic cystic tumors. PATIENTS AND METHODS: For MRCP, thick RARE and thin HASTE heavily T2-weighted sequences were performed with a 1.5 Tesla MR unit in 42 patients. Diffusion-weighted echo-planar sequences were performed in 16 patients. Surgical and histopathological correlation was obtained in 15 patients. RESULTS: MRCP detected all cystic lesions of the pancreas: 15 intraductal papillary mucinous tumors, 10 serous cystadenomas, 2 benign mucinous cystadenomas, 1 solid pseudopapillary tumor and 14 small cystic lesions (less than 2 cm) with no clinical signs. MRCP provided complete visualization of the pancreatic duct, showed excrescences within the dilated main or branch pancreatic ducts, identified microlacunar mixed and macrolacunar patterns, as well as septa, communications and stenosis, without contrast agent. MRCP did not characterize serous or mucinous cystic lesions. Specific diagnostic criteria of the various types of intraductal papillary mucinous tumors were noted (main duct, branch duct and combined types) and illustrated with the imaging findings necessary for accurate differential diagnosis. CONCLUSION: MRCP is a useful noninvasive and essential method in preoperative staging of cystic tumors of the pancreas; it is a reasonable alternative to endoscopic retrograde cholangiopancreatography and endosonography, as it provides the necessary information for treatment: surgical decision and/or follow-up.     

K-ras oncogene mutations indicate malignancy in cystic tumors of the pancreas.

OBJECTIVE: To evaluate clinical parameters, presurgical diagnostic tests, histologic findings, and the presence of K-ras oncogene mutations in cystic tumors of the pancreas to determine which best predict malignancy. SUMMARY BACKGROUND DATA: Because presurgical, intraoperative, and final pathologic differentiation is difficult in cystic tumors of the pancreas, it would be a major benefit to identify markers that accurately predict malignancy in these rare tumors. The role of K-ras oncogene mutations as an indicator of malignancy has not been determined in these tumors. METHODS: Nineteen patients with cystic tumors of the pancreas were evaluated, including K-ras mutation analysis based on polymerase chain reaction and restriction digestion assays and direct DNA sequencing, to screen for parameters that accurately predict malignancy. RESULTS: All malignant cystic pancreatic tumors (five cystadenocarcinomas and three mucin-producing adenocarcinomas) harbored K-ras mutations at codon 12 or 13. K-ras mutations were also detected in the percutaneous fine-needle aspirates of two of these patients. In contrast, none of nine benign cystadenomas or the solid-papillary neoplasm had K-ras mutations. None of the patients with a benign tumor carrying K-ras wild-type sequences developed recurrent disease after a mean follow-up of 50 months. Seven of the 8 malignant cystic pancreatic tumors, but none of the 11 benign tumors, showed dilatation of the main pancreatic duct on computed tomography or endoscopic retrograde cholangiopancreatography. CONCLUSIONS: K-ras mutation analysis seems to be a powerful tool to determine the malignant potential of cystic pancreatic tumors before and after surgery. Dilatation of the main pancreatic duct on computed tomography or endoscopic retrograde cholangiopancreatography is highly suggestive for malignancy in these rare tumors.