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。     

胰腺神经鞘瘤50例

目的:分析胰腺神经鞘瘤的特点并探讨其诊治方法.方法:对文献上报告的49例及我院收治的1例胰腺神经鞘瘤患者的临床特点进行回顾性分析.结果:胰头病变25例,胰体9例,胰体/尾部6例,胰尾部5例,胰头/体部2例,定位不明的2例,胰颈部1例.实性肿物18例,囊性25例,7例患者肿瘤的性质不能确定.49例患者手术切除,胰十二指肠切除术13例,远端胰腺切除术12例,肿物局部切除术12例,单纯肿物核除术8例,术式不明2例,肿物无法切除1例,活检1例,拒绝手术1例.随访时间最长的达到9a,无肿瘤复发和转移.结论:胰腺神经鞘瘤术前诊断困难,绝大部分为良性,恶性少见,确诊靠病理,良性者可行肿瘤核除术,恶性者可根治性切除,术中快速病理切片有助于决定手术方式.     

胰腺实性假乳头状肿瘤的外科治疗

胰腺实性假乳头状肿瘤(SPTP)是一种交界恶性的胰腺实体肿瘤,治疗方法以手术切除为主,目前主要采用肿瘤局部切除术、胰腺节段切除术、肿瘤扩大切除术,手术方式的选择取决于对肿瘤恶性程度的判断,术后并发症以胰瘘为主,保守治疗有效,完整切除肿瘤后,患者可获得长期生存。放射、化学治疗等辅助治疗效果尚不明确。     

胰腺实性假乳头状瘤的诊治

目的 探讨胰腺实性假乳头状瘤的临床诊治.方法 回顾性分析2005年10月至2008年12月间收治的10例胰腺实性假乳头状瘤患者的临床资料.结果 10例患者均为女性,年龄11～39岁,平均24岁.中上腹部不适或疼痛为主要症状,4例体检触及腹部包块.B超、CT及MRI检查显示胰腺实性或囊实性占位.术前实验室检查无明显异常,肿瘤标记物正常.所有病例均接受手术治疗,胰腺头颈部肿块6例,胰体尾部肿块4例.手术方式:肿块切除3例,胰体尾切除3例(2例保留脾脏,1例联合脾脏、远端胃及部分结肠切除),节段性胰腺切除3例,胰十二指肠切除1例.术后2例发生胰瘘,经非手术治疗治愈,无其他外科并发症.切除的肿块长径约5.9 cm.平均随访时间19.2个月(8～42个月),所有患者均存活,无肿瘤复发转移迹象.结论 胰腺实性假乳头状瘤是临床少见的低度恶性胰腺肿瘤,手术切除预后良好.     

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.     

胰腺黏液性囊腺瘤的诊断和外科治疗

目的 探讨胰腺黏液性囊腺瘤(MCN)的诊断和外科治疗效果.方法 回顾性分析2003年1月至2008年6月问在青岛大学医学院附属医院手术治疗的20例MCN患者的临床表现、病理特征、治疗方法和生存率等临床和随访资料.结果 患者以腹痛、上腹饱胀不适、恶心、呕吐为主要临床表现,11例有上腹部压痛,6例可触及上腹肿块.术前均行B超及CT检查,诊断13例为良性MCN,4例为胰腺浆液性囊腺瘤,3例为黏液性囊腺癌.肿瘤主要位于胰腺体、尾部,直径4～14 cm.20例均行手术治疗,以胰十二指肠切除术、胰体尾切除术为主.术后病理证实,良性MCN 10例,交界性MCN 3例,黏液性囊腺癌7例.术后平均随访26个月,良性MCN和交界性MCN患者均健在,无复发;黏液性囊腺癌患者3年生存率50%.结论 MCN主要好发于女性,临床表现无特征性,术前B超和CT检查可进行诊断,手术切除是惟一有效的治疗方法,预后较好.     

胰腺囊性病变的临床特征和诊治分析

背景:随着影像学技术的进步,胰腺囊性病变的检出率逐年升高,但鉴别不同类型的胰腺囊性病变仍是临床的棘手问题。目的:分析胰腺囊性病变的临床特征和诊治方法。方法:纳入2003年1月~2013年1月上海交通大学附属第一人民医院收治的胰腺囊性病变患者,对入组患者的临床表现、实验室检查、影像学特征以及治疗方法进行回顾性分析。结果:共49例患者纳入研究,其中假性囊肿13例、潴留囊肿4例、先天性囊肿2例、浆液性囊性肿瘤(SCN)9例、黏液性囊性肿瘤(MCN)11例、导管内乳头状黏液性肿瘤(IPMN)7例、实性-假乳头状肿瘤(SPN)3例。49例患者中16例患者无症状,其余33例患者表现为腹痛、腹胀、恶心、呕吐、发热等。13例胰腺假性囊肿患者均有急、慢性胰腺炎或外伤病史,3例IPMN患者血清CA19-9升高。B超、CT、MRI/MRCP、EUS诊断胰腺囊性病变的准确率分别为24.5%、32.7%、61.1%、100%。49例患者均接受手术治疗,分别行内引流术、囊肿切除术、胰十二指肠切除术、胰体(尾)切除术以及节段性胰腺切除术。结论:胰腺囊性病变无特异性临床表现。CT、MRI/MRCP作为无创检查手段,应广泛用于囊性病变的诊断和评估,EUS可作为进一步检查手段。选择合理的手术方案是治疗胰腺囊性病变的关键。     

胰腺内分泌肿瘤的外科治疗

目的提高对胰腺内分泌肿瘤的认知和诊疗水平。方法回顾性分析1968～2005年收治的78例胰腺内分泌肿瘤患者的临床资料。结果胰岛素瘤49例，均为良性，其中40例行单纯肿瘤摘除术（2例在腹腔镜下完成），2例在摘除的同时行胰腺空肠Roux—en—Y吻合术，7例行胰体尾切除术；胰高血糖素瘤4例，均有肝转移，行原发病灶及部分转移灶切除术；胰多肽瘤21例，恶性8例，手术切除16例，其余5例因肿瘤无法切除而放弃手术；舒血管肠肽瘤1例和胰腺类癌3例，均为恶性，行外科手术。术后均获得满意的疗效。结论手术切除是胰腺内分泌肿瘤最为理想的治疗方法。术前定性诊断尤为重要，关键是提高对这类肿瘤的认知水平。对胰岛素瘤不强求术前定位诊断，应慎用有创性诊断方法，术中胰腺探查是定位的关键。其他内分泌肿瘤术前多可依影像学检查定位诊断。手术方式根据肿瘤生长部位而定。姑息性切除手术亦可明显缓解症状。即便是恶性肿瘤，其预后亦明显好于胰腺外分泌肿瘤。     

胰腺内分泌肿瘤的诊断及手术治疗

对28例经手术治疗、病理检查证实的胰腺内分泌肿瘤（PETs）患者的临床资料作回顾性分析。发现PETs以胰岛素瘤、胰多肽瘤最常见,肿瘤大小与症状轻重无关;胰岛素瘤体积较小,术前定位诊断较难;胰多肽瘤无特定性症状,术前定性诊断较难。本组胰岛素瘤18例,均为良性,其中15例行单纯肿瘤切除术;胃泌素瘤1例为恶性,行胰尾联合全胃切除术;胰高血糖素瘤2例均为恶性,术中发现肝转移,1例行胰体尾联合肝转移灶切除术,1例行姑息性切除;胰多肽瘤7例,4例行肿瘤切除术,3例伴肝转移者中,1例行胰体尾姑息性切除术,2例无法切除。认为PETs术前诊断比较困难;手术切除是PETs最理想的治疗方法,手术方式根据肿瘤生长部位和性质而定。     

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。     

Central pancreatectomy:a new technique for resection of selected pancreatic tumors

BACKGROUND:Pancreatic tumors located in the neck region usually require pancreaticoduodenectomy or splenopancreatectomy.For small benign tumors enucleation is not usually feasible due to their size and localization;then pancreatectomy is often needed.Central pancreatectomy consists of a limited resection of the midportion of the pancreas and can be offered in benign and low-grade malignant tumors of the neck of the pancreas.The study aimed to evaluate whether central pancreatectomy has a place in pancreatic...     

Medial pancreatectomy

The surgical treatment of benign tumors of the midportion of the pancreas usually consists of enucleation or formal pancreatectomy. To avoid extended pancreatectomy, a limited resection of the neck of the pancreas has been proposed when enucleation is not feasible. Seven published series report a total number of 78 patients treated by this technique. No postoperative mortality was reported. The operative morbidity ranged from 0% to 40%, mainly due to pancreatic fistulas, which mostly healed spontaneously. In the long term no diabetes mellitus and/or exocrine insufficiency was observed. After resection of low-grade malignant tumors, there was no local recurrence. Medial pancreatectomy is a safe method for the treatment of benign or low-grade malignant tumors of the neck of the pancreas.     

Enucleation of intraductal papillary-mucinous tumor of the head of the pancreas. Report of 2 cases

Intraductal papillary-mucinous tumors of the pancreas are characterized by malignant transformation of unpredictable occurrence because of their unknown natural history. Surgical treatment is duodenopancreatectomy or left pancreatectomy even for benign tumors. We report 2 cases of benign intraductal papillary-mucinous tumor confined to the head of the pancreas and treated by enucleation.     

胰岛素瘤17例临床诊治分析

目的　探讨胰岛素瘤的诊断和治疗方法。　方法　回顾性地分析我院自 196 6年 ～ 2 0 0 0年收治的 17例胰岛素瘤。　结果　胰腺 B超、腹部 CT、选择性腹腔动脉造影检查准确率分别为 82 .4 %、72 .7%、6 0 %。2例未手术 ,15例肿瘤切除。肿瘤位于胰头钩突 3例 ,胰颈 1例 ,胰体尾 11例 ;80 %肿瘤直径 <3cm;行单纯肿瘤摘除术 8例 ,胰体尾切除术 4例 ,胰体尾加脾脏切除者 2例 ,胰腺节段性切除(捆绑式胰体尾空肠吻合空肠端侧吻合术 ) 1例。　结论　血糖、血胰岛素水平测定结合胰腺 B超、CT检查能有效提高功能性胰岛素瘤的诊断。治疗多为单纯性肿瘤切除 ,恶性肿瘤应行根治性切除 ,腹腔镜微创手术正处于尝试阶段 ,药物治疗仍然在探讨阶段。     

Segmental pancreatectomy for mucin-producing pancreatic tumors.

BACKGROUND/AIMS: Segmental pancreatectomy for benign tumors of the neck of the pancreas was reported in 1993. Mucin-producing carcinomas are generally regarded as low-grade malignancies as compared with ductal cell carcinomas of the pancreas. We report herein our experience with a segmental pancreatectomy for mucin-producing pancreatic tumors. METHODOLOGY: Three patients with mucin-producing tumors of the pancreatic body underwent a segmental pancreatectomy. After the pancreatic tumor had been located with intra-operative ultrasonography (US), the medial pancreas centered on the tumor was resected. The margin of the retained pancreas was submitted for histopathologic inspection intra-operatively to prevent retained disease. A conduit for draining the pancreatic juice consisted of a jejunal Roux-en-Y loop between the left and cephalic portions of the pancreas. Histologically, the 3 tumors were identified as a cystadenocarcinoma, an intraductal papillary adenocarcinoma, and a cystadenoma with a focus of borderline malignancy. The functional result was evaluated with oral glucose tolerance and pancreatic function diagnostic (PFD) testing. Pancreatic juice drainage was confirmed using magnetic resonance cholangiopancreatography (MRCP). RESULTS: Neither technical failure nor operative death occurred in any of the patients. The patients have been followed-up for between 33 months and 77 months after surgery and all are disease free. The oral glucose tolerance test and PFD test results were all within the normal range. MRCP showed good pancreatic juice drainage in the 2 patients examined. CONCLUSIONS: Segmental pancreatectomy may be an appropriate surgical procedure for mucin-producing pancreatic tumors, to prolong survival and to preserve endocrine and exocrine function.     

胰岛细胞瘤的外科诊治经验——附19例报告

目的：探讨胰岛细胞瘤的外科诊断与治疗。方法：回顾分析近5年我院手术的治疗胰岛细胞瘤的经验，总结胰岛细胞瘤临床特征，诊治方法及其效果。结果：本组19例病例中，无功能性胰岛细胞瘤8例，胰岛素瘤11例，其中2例为多发性内分泌瘤瘤，前恶变率62．5％（5／8），平均年龄40岁，后恶变率9．8％（1／11），平均年龄39岁，肿瘤位于胰头8例，胰体6例，胰尾5例，术前影像诊断明确肿瘤定位15例（78．9％），其余4例定位可疑或不能定位经术中超声和触摸探查到定位，对肿瘤行局部切除术11例，胰体尾切除＋胰空肠吻合术5例，肿瘤＋脾脏切除术2例，Whipple手术1例，术后胰瘘发生率为31．6％（6／19），是最常见的并发症，无手术死亡病例。结论：无功能性胰岛细胞瘤恶变率显高于胰岛素瘤（P＜0．01）。术前不能确定肿瘤位置的，应联合应用于中超声和术触摸以探查肿瘤部位。胰岛素瘤手术方式多为单纯肿瘤切除，无功能性胰岛细胞瘤，术中常规冰冻切片检查，对可疑恶性应尽量采取根治性手术。     

Robotic central pancreatectomy with pancreaticogastrostomy (transgastric approach) in a solid pseudopapillary tumor of the pancreas

Function preserving minimal invasive pancreatectomy is thought to be ideal approach for benign and borderline malignant tumors of the pancreas because these tumors can be expected for longterm survival. Pancreatic tumor in the neck of the pancreas is a challenging issue. Pancreaticoduodenectomy and distal pancreatectomy with/without splenectomy are the usual modes of surgery for them. Central pancreatectomy is a rare surgical procedure, even in open surgery. With the development of laparoscopic experiences, a few cases of laparoscopic central pancreatectomy have begun to be reported, but they are believed to be still demanding tremendous laparoscopic skills and experiences. However, advancements in technology have encouraged surgeons to overcome the limitations of conventional laparoscopic surgery. Herein, we report a case of robot-assisted central pancreatectomy with pancreaticogastrostomy (transgastric approach). Wrist-like movements of effector instruments and stable 3-D visualization provided by the robot surgical system are believed to enhance the precise and safe laparoscopic performance. More experiences need to be accumulated in order to evaluate the real value of robot pancreatic surgery.     

Laparoscopic distal pancreatectomy for neuroendocrine tumors of the pancreas

Although neuroendocrine tumors of the pancreas are traditionally managed by laparotomy, these rare neoplasms may be amenable to laparoscopic surgical resection. We present our experience with laparoscopic distal pancreatectomy in two such patients, and discuss the operative technique with emphasis on organ preservation. Two female patients aged 63 and 69 years presented with clinical and biochemical features of an insulinoma and a vasoactive intestinal peptide secreting tumor (VIPoma), and were found on cross-sectional imaging to have 1.2-cm and 4.5-cm solitary tumors in the tail of the pancreas. They underwent laparoscopic distal pancreatectomy with and without preservation of splenic vessels and spleen respectively. Both procedures were completed laparoscopically. The operating time was 180 and 210 minutes respectively. There were no postoperative complications. The postoperative hospital stay was 4 and 14 days respectively. Histology revealed a benign insulinoma and a malignant VIPoma with lymph node metastases respectively. Laparoscopic distal pancreatectomy for neuroendocrine tumors of the pancreas may be accomplished safely, with preservation of the spleen and splenic vessels in benign disease, and with benefits to the patients in terms of postoperative recovery.