胰腺囊性肿瘤临床诊治分析

目的探讨胰腺囊性肿瘤的诊治方法。方法回顾性分析29例胰腺囊性肿瘤患者的临床资料,包括一般资料、临床表现、辅助检查、手术方法、病理结果、术后并发症和随访结果。结果 8例(28%)浆液性囊性肿瘤(SCN),12例(41%)黏液性囊性肿瘤(MCN),3例(10%)导管内乳头状黏液肿瘤(IPMN),6例(21%)实性假乳头状肿瘤(SPT)。8例SCN、7例MCN、1例IPMN和5例SPT均是良性肿瘤。76%(22/29)患者是女性,年龄(49±17)岁(15～78岁)。29例中行手术治疗23例,其中切除肿瘤22例,探查活检1例,围手术期无死亡病例;另外6例未手术者中4例SCN者行随访观察处理,2例IPMN者拒绝手术治疗。29例患者中获随访21例,随访时间为(2.7±2.3)年(6个月～8年),失访8例。16例肿瘤切除者随访期内肿瘤无复发,1例探查活检者术后1年死亡;4例未手术的SCN患者随访期内肿瘤无明显增大。结论胰腺囊性肿瘤中最常见的是黏液性肿瘤和浆液性肿瘤,多见于女性;浆液性肿瘤均为良性,42%的黏液性肿瘤是恶性;误诊将延误治疗,增加死亡率。胰腺囊性肿瘤手术切除率高,根治性切除后预后好。     

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的诊断与治疗

目的提高对胰腺导管内乳头状黏液性肿瘤(IPMTs)的认识,以改善其诊治水平。方法对1993年5月至2003年12月收治的15例IPMTs病人的临床、影像学表现及病理资料作回顾性分析。结果15例中男性12例,女性3例。年龄33～76岁,平均58岁。上腹痛为最常见症状。B超和CT检查,均提示有不同程度的胰管扩张和囊实性占位。11例行ERCP检查,发现十二指肠乳头肿大和黏液溢出者7例。14例行手术治疗(胰十二指肠切除术12例,胰体尾切除1例,全胰切除1例)。术后病理诊断胰头导管内乳头状黏液性腺癌3例、导管内乳头状黏液性腺瘤伴局部癌变6例、胰头导管内乳头状黏液性腺瘤伴不典型增生3例、胰头导管内乳头状黏液性腺瘤2例,术后除1例因肝广泛转移而死亡外,其余病人均健在,存活期最长1例已13年。结论胰腺有囊实性占位伴胰管全程扩张的病人应考虑IPMTs,ERCP发现十二指肠乳头增大有黏液溢出者可确诊该疾病。手术切除是最有效的治疗,术后预后良好。     

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。     

Comparison of clinicopathological characteristics of mucinous adenocarcinoma and conventional adenocarcinoma of gallbladder

BackgroundGallbladder mucinous adenocarcinoma (GBMAC) is a rare type of gallbladder malignant tumor, whereas little is known regarding the clinicopathological features and surgical outcomes of GBMAC.MethodsFrom January 2000 till December 2015, 54 GBMAC patients who underwent curative-intent surgical resection at our institution were retrospectively reviewed. We compared the clinicopathological features and surgical outcomes of these GBMAC patients with a relatively large cohort of surgically resected conventional gallbladder adenocarcinoma (GBAC) patients without existence of mucinous components.ResultsThe clinicopathological features of GBMAC were significantly different from conventional GBAC, including poorer tumor differentiation (P < 0.001), higher CA19-9 levels (P < 0.001), larger tumor sizes (P = 0.020), advanced AJCC tumor stage (P = 0.002), higher frequency of liver parenchyma invasion (P = 0.020), portal vein invasion (P = 0.003), lymph node metastasis (P = 0.016), lympho-vascular invasion (P < 0.001) and perineural invasion (P = 0.025). Relative to conventional GBAC patients, GBMAC patients showed significantly worse overall survival (OS) (29.0 vs 15.0 months; P < 0.001). Multivariate analysis confirmed the surgical margin (P = 0.046), tumor differentiation grade (P = 0.018), lymph node metastasis (P = 0.024), and presence of signet-ring cell component (P = 0.005) as independent prognostic factors influencing OS of patients with GBMAC.ConclusionGBMAC always had more aggressive biological behaviors and poor survival outcomes even after curative surgery. GBMAC patients with the presence of signet-ring cell component showed even worse survival outcome.     

Intraductal papillary mucinous tumor of the pancreas associated with autosomal dominant polycystic kidney disease

A 43-year-old male with a history of autosomal dominant polycystic kidney disease (ADPKD) was admitted to our center with severe abdominal pain and was diagnosed with acute pancreatitis. CT showed multiple cysts in the liver and both kidneys along with ADPKD and a cystic mass, 4 cm in diameter, in the pancreatic head. The main pancreatic duct was dilated to 1 cm in diameter. The patient was diagnosed with acute pancreatitis due to intraductal papillary mucinous tumor (IPMT), and pancreatoduodenectomy was performed. Histologic examination revealed a multiloculated cystic tumor filled with mucin in the head of the pancreas. Microscopically, the tumor was diagnosed as adenocarcinoma and was found to have invaded the main pancreatic duct. Although, in addition to our case, only seven cases with association between ADPKD and malignant neoplasms have been reported, five of these cases had neoplasms arising from the pancreas. Therefore, we suggest that some genetic interactions may exist between ADPKD and pancreatic carcinogenesis.     

以胆管炎起病的胰腺导管内乳头状粘液瘤一例并文献复习

胰腺导管内乳头状粘液瘤(IPMN)为胰腺囊性肿瘤之一,特点为囊肿与胰管相通,伴胰管扩张。病理表现为囊肿分泌大量粘液及囊壁结节堵塞胰管,导致胰管扩张。文献报道临床以腹痛发病最为常见,本病例以少见的胆管炎表现起病,现报告并作文献复习如下。     

良、恶性胰腺导管内乳头状黏液性肿瘤CT特征与病理联系

目的 探讨良、恶性胰腺导管内乳头状黏液性肿瘤(P-IPMN) CT特征及其病理联系.方法 搜集并分析在本院治疗的40例P-IPMN患者影像学及病理资料,所有患者都进行了CT平扫加增强检查,运用统计学方法分析良、恶性P-IPMN的病理学及影像学差异.结果 良、恶性P-IPMN在性别、发病年龄、发病部位、有无慢性胰腺炎病史上无显著性差异(P＞0.05);在病灶大小、胆总管扩张、壁结节大小、主胰管扩张程度、CA19-9是否升高上有显著性差异(P＜0.05).结论 良、恶性P-IPMN的CT表现具有一定特征性,影像学检查能为临床医师术前判断其生物学特性提供重要参考.     

F-18-fluorodeoxyglucose positron emission tomography in differentiating malignant from benign pancreatic cysts: A prospective study

The differential diagnosis between benign and malignant pancreatic cystic lesions may be very difficult. We recently found that F-18-.uorodeoxyglucose positron emission tomography (18-FDG PET) was useful for the preoperative work-up of pancreatic cystic lesions. This study was undertaken to confirm these results. From February 2000 to July 2003, 50 patients with a pancreatic cystic lesion were prospectively investigated with 18-FDG PET in addition to helical computed tomography (CT) and, in some instances, magnetic resonance imaging (MRI). The validation of diagnosis was based on pathologic findings after surgery (n = 31), percutaneous biopsy (n = 4), and according to follow-up in 15 patients. The 18-FDG PET was analyzed visually and semiquantitatively using the standard uptake value (SUV). The accuracy of FDG PET and CT was determined for preoperative diagnosis of malignant cystic lesions. Seventeen patients had malignant cystic lesions. Sixteen (94%) showed increased 18-FDG uptake (SUV >2.5), including two patients with carcinoma in situ. Eleven patients (65%) were correctly identified as having malignancy by CT. Thirty-three patients had benign tumors: two patients showed increased 18-FDG uptake, and four patients showed CT findings of malignancy. Sensitivity, specificity, positive and negative predictive value, and accuracy of 18-FDG PET and CT in detecting malignant tumors were 94%, 94%, 89%, 97%, and 94% and 65%, 88%, 73%, 83%, and 80%, respectively. 18-FDG PET is accurate in identifying malignant pancreatic cystic lesions and should be used in combination with CT in the preoperative evaluation of patients with pancreatic cystic lesions. A negative result with 18-FDG PET may avoid unnecessary operation in asymptomatic or high-risk patients. Presented at the Forty-Fifth Annual Meeting of The Society for Surgery of the Alimentary Tract, New Orleans, Louisiana, May 15–19, 2004 (oral presentation). This study was supported by the Ministero Università e Ricerca Scientifica (Cofin 2001068593-001), Rome, Italy.