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1966年～2000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%、60%.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＜3 cm;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.     

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。     

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.     

内镜超声引导下无水乙醇消融术治疗胰腺囊性肿瘤的初步研究(含视频)

目的 评价内镜超声引导下无水乙醇消融术（EUS-EA）治疗胰腺囊性肿瘤的可行性、安全性及有效性。方法 回顾性分析2013年7月至2017年4月在上海长海医院接受EUS-EA的10例胰腺囊性肿瘤患者的基本信息、EUS特征、术后并发症、随访情况等资料。根据术后随访的影像学资料评估EUS-EA疗效。结果 10例患者瘤体最长径平均为（2.95±1.56）cm,囊液分析结果显示6例浆液性囊腺瘤,3例黏液性囊腺瘤,1例未定型囊腺瘤。10例患者共行12次EUS-EA,手术均成功,未出现有临床意义的感染、胰腺炎、出血、胰瘘等严重并发症。术后中位随访时间4.0个月（3.0~12.0个月）,3例完全缓解,6例部分缓解,1例稳定,无进展病例。结论 EUS-EA治疗胰腺囊性肿瘤手术成功率高、并发症少、总体疗效较好。     

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.     

12例胰腺实性假乳头状瘤的诊治分析

背景:胰腺实性假乳头状瘤(SPTP)是一种罕见的胰腺交界性肿瘤,临床表现缺乏特异性,早期易误诊。目的:探讨SPTP的临床诊治特点。方法:收集2002年10月～2009年9月大连医科大学附属第二医院12例确诊SPTP患者的病例资料,对其临床表现、病理特点、治疗以及预后进行回顾性分析。结果:本组12例患者均为女性,年龄11～30岁,均为单发肿瘤,肿瘤直径1.30～10.80 cm,中位直径6.05 cm。患者无特异性临床表现,主要表现为上腹部疼痛、恶心、呕吐等。患者均行B超、CT、MRI检查,肿瘤位于胰头部3例、胰颈部2例、胰体尾部7例,B超诊断为SPTP 8例,CT诊断为SPTP 10例,MRI诊断为SPTP 10例。所有患者均接受手术治疗,术后由组织病理学检查确诊为SPTP。患者术后均未出现肿瘤复发、转移。结论:SPTP是一种交界性胰腺肿瘤,好发于年轻女性,确诊需依靠组织病理学检查,手术是SPTP的有效治疗方法。     

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例拒绝手术治疗.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.     

Operative indications for cystic lesions of the pancreas with malignant potential--our experience

BACKGROUND/AIMS: There are still many important but unclear points regarding the differential diagnosis and operative indications of cystic lesions of the pancreas with malignant potential. Studies of the clinicopathological and molecular biological characteristics of such diseases are necessary. In this paper, we discuss operative indications for this condition based on a review of the literature and our own experience. METHODOLOGY: Seven cases of serous cystadenoma and 9 cases of mucinous cystadenoma or cystadenocarcinoma of the pancreas that were operated on or autopsied in our department from 1980 to 1996 were analyzed clinicopathologically. Small cystic lesions incidentally found in 300 autopsied cases were also studied. Finally, mucin-producing tumors described in several reports were reviewed, and the branch type of this tumor was especially investigated. RESULTS: A marked disappearance of pancreatic acini in the upstream pancreas was found when serous cystadenoma became large. Papillary projection was histologically found in all of the cases. Tumorous invasion to the interstitium was suspected in tumors more than 5 cm in diameter, and malignancy was reported when tumors were larger than 6 cm. As for mucinous cystadenocarcinoma, the patients had a poor prognosis. In 2 of 42 cases with a pseudocyst, small duct cell carcinoma was incidentally found adjacent to the pseudocyst on the duodenal side. With regard to branch-type intraductal papillary neoplasm, 80% of the tumors larger than 4 cm were malignant. Most of the small cystic lesions found in elderly autopsy cases were accompanied by hyperplastic epithelia without evidence of malignancy. CONCLUSIONS: Based on our experience, an operation should be considered and resection is recommended under the following circumstances: 1) cystic lesions in the body and tail of the pancreas in middle-aged women; 2) typical serous cystadenoma larger than 4 cm; 3) mucinous cystadenoma of any size; 4) branch-type intraductal papillary neoplasm larger than about 3 cm; and, 5) pseudocysts of unknown cause. Small cystic lesions in elderly patients should not necessarily be operated on, but should be followed-up carefully.     

Cystic neoplasms of the pancreas

Cystic neoplasms of the pancreas, including 4 patients with serous cystadenoma and 11 with mucinous cystic neoplasm, were studied. Serous cystadenomas composed of epithelial cells with glycogen in the cytoplasm were benign in all, whereas mucinous cystic neoplasms consisted of four benign, two borderline, and five malignant lesions. The average size was 1.8 cm in the greatest diameter in benign mucinous cystadenomas, about 5 cm in borderline tumors, and more than 8 cm in mucinous cystadenocarcinomas. Histologically, in all borderline and malignant lesions, the cysts contained areas lined with epithelium and had a benign appearance, comparable with that of mucinous cystadenoma. These observations suggest a borderline or malignant disease in the case of a benign mucinous cystadenoma. An immunohistochemical study for carcinoembryonic antigen and carbohydrate antigen 19-9 showed denser and diffuse localizations of such materials in the cytoplasm and the stroma in the case of malignant lesions, as compared to findings in borderline and benign cases.     

Serous Cystadenoma of the Pancreas: Clinical and Pathological Features in 33 Patients

Aim: To report the clinicopathological features of patients with serous cystadenomas of the pancreas. Methods: Thirty-three cases of serous cystadenoma diagnosed between 1977 and 2006 were retrieved from the files of the Ohio State University Medical Center. Clinical data and microscopic slides were reviewed. Results: The patients included 27 women and 6 men with an age range of 38–83 (mean 64.3) years. The clinical presentation included 13 patients with abdominal pain and 8 patients with abdominal mass; 9 tumors were found incidentally. Abdominal CT scans in 25 patients were interpreted as suspicious for carcinoma in 8 (32%), suspicious for serous cystadenoma in 8, neoplasm not otherwise specified in 8, and suspicious for a pseudocyst in 1.Only 7 patients underwent a preoperative biopsy, and 5 of these were diagnosed as having a serous cystadenoma. All but 2 of the patients underwent surgical resection of the tumor. The serous cystadenomas varied in size from 1.0 to up to 13 cm in maximum dimension, and all but one had a multicystic appearance. Of the 33 serous cystadenomas, 20 (61%) were located in the pancreatic tail, 4 (12%) in the pancreatic body, 4 in the pancreatic body and tail, and 5 (15%) in the head of the pancreas. Follow-up in 17 patients (median 3 years, range from 1 month to 11 years) showed no recurrence of serous cystadenomas. One patient had von Hippel-Lindau syndrome, 4 patients had diabetes mellitus, 3 patients had metastatic cancer, and 2 patients had ovarian tumors. Conclusions: Serous cystadenoma is an uncommon neoplasm that can be confused with malignancy both clinically and radiologically; a correct diagnosis is important in order to provide an accurate prognosis.     

胰头部囊腺瘤局部切除术前内镜下置入胆胰管支架的安全性及疗效分析

为探讨内镜逆行胰胆管造影（endoscopic retrograde cholangiopancreatography，ERCP）下胆胰管支架置入联合胰腺局部切除术（enucleation，En）治疗胰头部囊腺瘤的安全性与临床疗效，回顾性分析2020年1月—2023年1月杭州市第一人民医院行ERCP+En（ERCP+En组，n=11）与En（En组，n=12）治疗的胰头部囊腺瘤患者临床资料，对比两组一般情况、术中情况、围术期并发症、住院时间及随访结果。两组患者一般资料差异无统计学意义（P>0.05）。ERCP+En组中，ERCP置入胆胰管支架顺利，术后出现高淀粉酶血症3例，经保守治疗好转。两组En术中均无中转开腹、输血发生，术后均无严重并发症。ERCP+En组与En组术后B/C级胰瘘分别为0例和3例（P=0.001），中位住院时间分别为11 d和15 d，差异有统计学意义（U=2.25，P=0.031）；两组中位En时间（145 min比155 min，U=0.03，P=0.952）、中位术中出血量（100 mL比120 mL，U=0.05，P=0.784）差异无统计学意义。中位随访18个月，两组患者均无复发，ERCP+En组无胆胰管狭窄发生，En组中2例发生胰管狭窄，1例发生胆管狭窄。内镜下胆胰管支架置入联合En治疗胰头部囊腺瘤可有效减少术后胰瘘，避免远期胆胰管狭窄等并发症。     

A case of macrocystic serous cystadenoma of the pancreas

Summary A case of macrocystic serous cystadenoma of the pancreas is presented, and literature is reviewed. A 35-yr-old woman presented with mild upper abdominal pain. Abdominal ultrasonography and an abdominal computed tomography revealed a multiloculated and calcified cyst in the body of the pancreas. A T1-weighted image, using magnetic resonance imaging, revealed a low-intensity mutiloculated, pancreatic mass. In contrast, T2-imaging of the tumor showed a high-intensity mass. Endoscopic retrograde cholangiopancreatography showed no contact between the main pancreatic duct and the tumor. The preoperative diagnosis was a mucinous cystic neoplasm. Tumor enucleation was performed. Subsequent microscopic examination of this tumor suggested the diagnosis of a macrocystic serous cystadenoma of the pancreas.     

Pancreatic benign schwannoma treated by simple enucleation: case report and review of literature

Benign schwannoma in the pancreatic head is very rare, with only 11 patients being reported in the English literature from a Medline search. Furthermore, only 1 of them was treated by simple enucleation. Herein, we present another enucleation case: a 71-year-old male patient with a 1.5 x 1.2-cm low-density mass, mimicking a cystic lesion located at the head of pancreas, which was detected by computed tomography. This tumor failed to be discovered by abdominal ultrasound. At laparotomy, a solid mass 1 cm in diameter was identified; it was the smallest one in the pancreatic head according to the 11 previous reported cases. No complications were found after the operation. At 10-month follow-up, the patient remains asymptomatic and has no signs of recurrence. The data of the 12 patients indicated that simple minimal invasive enucleation for small benign schwannoma in the pancreatic head was feasible and safe; early detection and early treatment of the tumor were helpful in increasing the ratio of enucleation and avoiding a very invasive Whipple operation.     

Management of cystic neoplasms of the pancreas

BACKGROUND/AIMS: Despite the growing interest in cystic neoplasms of the pancreas, their diagnosis, treatment and prognosis are still obscure and controversial. METHODOLOGY: We studied, from September 1989 to July 1999, 21 patients (18 women) with an average age of 54.3 years who were submitted to surgical treatment for cystic neoplasms of the pancreas. Ultrasonography and computed tomography were performed in all patients. RESULTS: The treatment performed was surgical resection: cephalic gastroduodenopancreatectomy, 4 patients; body and tail pancreatectomy, 11 patients; only tail pancreatectomy, 2 patients; and two other patients were submitted to enucleation of one small lesion in the head of the pancreas. Internal drainage, through cystogastrostomy or cystojejunostomy, was performed in 3 cases. Site of tumor: body and tail region, 14 cases; head of the pancreas, 7 cases. Three patients had postoperative complications (respiratory tract infection, surgical wound infection, abdominal abscess). Three patients developed diabetes mellitus during the late postoperative period. One patient died 45 days after surgical procedure. CONCLUSIONS: Patients who present pancreatic cystic lesions should be submitted to surgery when local and medical conditions allow it and when intraoperative frozen biopsy excludes a pancreatic pseudocyst. If the nature of the lesion cannot be determined, it is better to err resecting a pseudocyst than by leaving or draining a cystic neoplasm, since these lesions are potentially curable.     

Surgical treatment for serous cystadenoma of pancreas--segmental pancreatectomy or conventional resection?

BACKGROUND/AIMS: Benign tumors located in the neck or body of the pancreas are usually removed by left pancreatectomy or pancreaticoduodenectomy when enucleation is too risky for possible damage of the main pancreatic duct. But standard pancreatic resection has its potential operative risk and may result in loss of pancreatic parenchyme and cause impairment of pancreatic function. The aim of this study was to compare the results of segmental pancreatectomy, a limited resection of the mid-portion of the pancreas, and traditional extensive pancreatic resection, i.e. distal pancreatectomy or pancreaticoduodencetomy in patients with serous cystadenoma of the pancreas. METHODOLOGY: From January 1989 to February 2002, 19 patients with serous cystadenoma of the pancreas treated with pancreatic resection were reviewed. Among them segmental pancreatectomy was performed in 5 cases, distal pancreatectomy was carried out in 11, pancreaticoduodenectomy in 2 and total pancreatectomy in one patient. RESULTS: Operation time was significantly longer in segmental pancreatectomy than in distal pancreatectomy (P<0.001) and a greater blood loss was also noticed in the conventional resection. There was no operative mortality and the postoperative hospital stays were not different in any group. A higher rate of pancreatic fistula was encountered in segmental pancreatectomy, however all of the fistulas sealed off after conservative treatment. A trend of higher chance of developing postoperative diabetes was noticed in the conventional resection. Except for the patient who underwent total pancreatectomy no patient developed frank steatorrhea during long-term follow-up. CONCLUSIONS: Segmental pancreatectomy is a safe and technically feasible procedure in selected patients with benign pancreatic tumor. This procedure carries a similar surgical risk as that of standard operation, but avoids extensive pancreatic resection which in turn may preserve more pancreatic functions.     

Pancreatic schwannoma: Case report and an updated 30-year review of the literature yielding 47 cases

Pancreatic schwannomas are rare neoplasms. Authors briefly describe a 64-year-old female patient with cystic pancreatic schwannoma mimicking other cystic tumors and review the literature. Databases for PubMed were searched for English-language articles from 1980 to 2010 using a list of keywords, as well as references from review articles. Only 41 articles, including 47 cases, have been reported in the English literature. The mean age was 55.7 years (range 20-87 years), with 45% of patients being male. Mean tumor size was 6.2 cm (range 1-20 cm). Tumor location was the head (40%), head and body (6%), body (21%), body and tail (15%), tail (4%), and uncinate process (13%). Thirty-four percent of patients exhibited solid tumors and 60% of patients exhibited cystic tumors. Treatment included pancreaticoduodenectomy (32%), distal pancreatectomy (21%), enucleation (15%), unresectable (4%), refused operation (2%) and the detail of resection was not specified in 26% of patients. No patients died of disease with a mean follow-up of 15.7 mo (range 3-65 mo), although 5 (11%) patients had a malignancy. The tumor size was significantly related to malignant tumor (13.8 ± 6.2 cm for malignancy vs 5.5 ± 4.4 cm for benign, P = 0.001) and cystic formation (7.9 ± 5.9 cm for cystic tumor vs 3.9 ± 2.4 cm for solid tumor, P = 0.005). The preoperative diagnosis of pancreatic schwannoma remains difficult. Cystic pancreatic schwannomas should be considered in the differential diagnosis of cystic neoplasms and pseudocysts. In our case, intraoperative frozen section confirmed the diagnosis of a schwannoma. Simple enucleation may be adequate, if this is possible.