36例胰腺浆液性囊腺瘤的临床分析

目的：探讨胰腺浆液性囊腺瘤的诊断和治疗。方法：对1998年6月至2006年9月瑞金医院收治的36例病理诊断为胰腺浆液性囊腺瘤的临床资料进行回顾性分析。结果：胰腺浆液性囊腺瘤好发于中老年女性,多见于胰腺头颈部,无特征性临床表现。B超和CT诊断囊性肿瘤的正确率分别为69%（25/36）和94%（34/36）。CT对于囊腺瘤的诊断正确率为80%（29/36）,对浆液性囊腺瘤的诊断正确率为61%（22/36）。在不能排除或考虑实性假乳头状瘤的病人中MRI对于囊腺瘤的诊断正确率80%（4/5）。本组35例行手术治疗,其中7例行胰十二指肠切除;11例行胰腺节段切除;12例行胰体尾切除;5例行局部切除,1例行剖腹探查活组织检查。10例术后出现并发症,包括胰瘘、内出血、幽门梗阻、胰腺假性囊肿合并肠瘘病人及不同程度的胸腔积液。1例因内出血死亡。本组3例失访,32例获随访,除2例因其它疾病死亡,其余均健在,术后无复发。结论：CT和MRI,结合肿瘤学指标和临床病理特征可大大提高浆液性囊腺瘤的术前诊断率。浆液性囊腺瘤是一种良性的肿瘤,但手术治疗并发症较多。大多数浆液性囊腺瘤可考虑随访;有症状的胰腺浆液性囊腺瘤,或与黏液性囊性肿瘤不能鉴别者,应手术治疗。     

Biliary cystadenoma with mesenchymal stroma of the liver: Correlation between unusual MR appearance and pathologic findings

We reported a case of the biliary cystadenoma of the liver. The cystic mass had labulation and septation and showed marked hyperintensity on T1-weighted images and hypointensity on T2-weighted images; MR findings were very unusual for cystadenoma. The content of the cystic mass was jelly-like, thick mucinous fluid without intracystic hemorrhage. We concluded that these unusual signal intensities of the cyst were due to hyperproteinous mucinous fluid.     

Intrahepatic biliary cystadenoma: A case report

BACKGROUNDBiliary cystadenoma (BCA) is a rare benign tumor, accounting for only 5% of reported cystic lesions of the liver. Given its potential for malignancy and high rate of recurrence, surgical resection is the preferred treatment. Therefore, early and accurate preoperative diagnosis is critical to the choice of treatment. We here report the first male case of BCA in our hospital, diagnosed by our team and confirmed by pathological biopsy. This article aims to improve the understanding of this disease and help make a correct diagnosis to better manage it.CASE SUMMARYA 58-year-old man with irregular abdominal discomfort came to our clinic and was found to have a distended abdomen during physical examination. Computed tomography and magnetic resonance imaging both showed a huge cystic mass in the liver. The patient underwent left hepatic lobectomy, cholecystectomy, and liver cyst fenestration, and most of the masses had decreased in size as of the 6-mo follow-up. The pathological diagnosis was consistent with BCA, and no recurrence was detected after the surgery. BCA occurred mainly in middle-aged women. To the best of our knowledge, this patient is the 11th male case of BCA reported in the literature.CONCLUSIONThe combination of magnetic resonance imaging and magnetic resonance cholangiopancreatography is of great significance for the early accurate diagnosis of the disease and the choice of surgical methods.     

卵巢囊腺瘤的CT诊断

目的:提高对卵巢囊腺瘤CT诊断及鉴别诊断能力。方法:回顾性分析手术病理证实的27例卵巢囊腺瘤的CT表现。结果:浆液性囊腺瘤5例,单房4例,多房1例,密度均匀,囊壁可薄可厚或厚薄不均。粘液性囊腺瘤9例,单房3例,密度均匀,囊壁厚,多房6例,密度不均匀,内见多发大小不等子囊。交界性(6例)和恶性变(7例)13例,其中浆液性3例,粘液性10例,12例为多房改变,囊壁及分隔增厚且边缘模糊,部分呈囊实性及壁结节改变,2例恶性变者伴有大量腹水。结论:单房浆液性囊腺瘤及多房粘液性囊腺瘤具有较典型CT表现,CT易于诊断及鉴别诊断,当病变呈囊实性改变,出现壁结节,或囊壁分隔不规则增厚模糊时,提示交界性或恶性变。     

胰腺囊腺瘤和囊腺癌的诊断及外科治疗

目的探讨胰腺囊腺瘤和囊腺癌的诊断和治疗方法。方法对2000年6月～2005年6月复旦大学附属中山医院收治的24例胰腺囊腺瘤和囊腺癌的临床资料进行回顾性分析。结果胰腺囊腺瘤和囊腺癌无特征性临床表现。B超和CT对胰腺囊性肿瘤的诊断正确率分别达到88%(21/24)和92%(22/24),但不能准确区分其类型。3例浆液性囊腺瘤未行手术治疗;21例手术者中,行胰十二指肠切除术9例,远端胰腺切除术8例,胰腺节段切除术1例,肿瘤摘除术3例,胰瘘是主要的并发症。本组患者均获随访,3例未手术者肿瘤无增大,1例囊腺癌因复发转移于术后11个月死亡,其余均健在,术后无复发。结论B超和CT是胰腺囊性肿瘤主要的影像学检查方法。黏液性囊性肿瘤以及伴有症状的浆液性囊腺瘤需手术治疗。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。     

胰腺巨大囊性实质性肿瘤的诊断和治疗

目的 探讨胰腺巨大囊性实质性肿瘤术前有效的诊断和外科治疗方法。方法 回顾性总结分析巨大胰腺囊性实质性肿瘤（直径〉8cm）的术前诊断方法和手术治疗结果。结果 复旦大学华山医院外科自1999年至今收治15例直径〉8cm的胰腺囊性实质性肿瘤，均行根治性手术切除。病理诊断：实性假乳头状瘤9例，囊腺瘤4例，囊腺癌2例。结论 胰腺巨大囊性实质性肿瘤的诊治较为困难，螺旋CT、DSA结合肿瘤标记物检测有助于肿瘤的诊断和可切除性判断，手术切除仍是目前主要的治疗手段。     

Spontaneous rupture of a hepatic cystadenoma and cystadenocarcinoma: report of two cases

Hepatobiliary cystadenomas and cystadenocarcinomas are rare tumors. Differentiating between these tumors and benign hepatic cysts may be difficult. Because of their rarity, diagnosis is often delayed and may result in inaccurate treatment, resulting in unnecessary morbidity and mortality. The purpose of this report is to draw attention to these entities and their complications. We report on two cases with spontaneous rupture of hepatobiliary cystadenoma and cystadenocarcinoma cysts, initially treated as simple hepatic cysts by aspiration, or by aspiration combined with sclerotherapy. The spontaneous rupture of the cysts appeared years after the initial treatment of the cysts, leading in one case to a prolonged stay in an intensive care unit. In both cases, a formal liver resection was carried out and microscopic investigations revealed a mucinous cystadenocarcinoma and cystadenoma. In conclusion, although hepatobiliary cystadenomas and cystadenocarcinomas are rare findings, they should not be forgotten in the diagnostic workshop when examining patients with hepatic cysts. If hepatobiliary cystadenomas and cystadenocarcinomas cannot be excluded following radiological imaging, surgery is recommended.     

Laparoscopic distal pancreatectomy

Background: Advanced laparoscopic techniques have been adapted to various surgical pathologies, including pancreatic tumors, with the potential benefits of attenuated surgical trauma, faster recovery, and improved cosmesis. Laparoscopic pancreatic surgery is technically demanding, and thus has not yet gained widespread acceptance. The aim of this study was to review our preliminary experience with laparoscopic distal pancreatectomy for benign and malignant pancreatic pathologies.Methods: A retrospective chart review of consecutive patients with benign and malignant pancreatic tumors who underwent laparoscopic distal pancreatectomy in a university-affiliated department of surgery between 1997 and 2003 was performed. Data relative to demographic and clinical characteristics, indications for surgery, surgical procedure, and postoperative course were recorded.Results: Laparoscopic distal pancreatectomy was attempted for 12 patients with benign (n = 8) and malignant (n = 4) pancreatic tumors and successfully completed laparoscopically in 75%, of these cases. Six early postoperative complications (two abscesses, two instances of diabetes mellitus, two pancreatic leaks) developed in three patients. The spleen was successfully preserved in 58% of the cases.Conclusions: This preliminary experience suggests that laparoscopic distal pancreatectomy is a feasible and safe procedure with a morbidity rate comparable with that for the conventional open procedure. However, laparoscopic surgery for malignant pancreatic tumors remains controversial. Larger series with longer follow-up periods are necessary to determine the role of laparoscopic surgery in the treatment of pancreatic pathologies.Presented as a poster at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Denver, Colorado, 31 March 3–April, 2004     

CT在卵巢囊腺瘤及囊腺癌诊断中的应用

目的探讨CT诊断卵巢囊腺瘤及囊腺癌的价值。方法回顾分析35例经临床手术及病理证实的卵巢囊腺瘤与囊腺癌的CT表现。结果35例中浆液性囊腺瘤17例,粘液性囊腺瘤10例;浆液性囊腺癌6例,粘液性囊腺癌2例;囊腺瘤表现为壁薄、光滑的单房或多房囊性肿块,无壁结节;囊腺癌表现为囊壁及间隔不规则增厚,多有壁结节或肿块实性部分。结论卵巢囊腺瘤及囊腺癌有特征性的CT表现,CT在其诊断和鉴别上有价值。