胰腺囊腺瘤和囊腺癌的临床病理特点及诊治体会

目的探讨胰腺囊腺瘤和囊腺癌的临床病理特点及其诊治方法。方法回顾性分析1996年6月—2007年3月收治的17例患者的临床病理资料。结果全组临床表现无特征性。B超和CT检查能发现囊肿但不能确定类型。浆液性囊腺瘤7例均行肿瘤局部切除,黏液性囊腺瘤6例行胰十二指肠切除1例,胰体尾切除5例;囊腺癌4例行胰十二指肠切除加淋巴结清扫1例,胰体尾切除术2例,胰体尾加脾切除1例。病理标本多呈多房囊腔,囊腔与胰管不通。15例获得随访,中位随访时间43(1～129)个月,1例囊腺癌行胰体尾加脾切除的老年患者术后6个月营养不良衰竭死亡;其余患者均生存,经B超检查均未见肿瘤复发,仅1例胰十二指肠切除术后患者出现糖尿病,疗效满意。结论B超和CT是该病的主要影像检查方法。加强对该病临床病理特征的认识是提高诊治率的关键,手术切除治疗疗效满意。

The clinicopathologic features,diagnosis and treatment of pancreatic cystadenoma and cystadenocarcinoma

Objective To study the clinicopathologic features,diagnosis and treatment of pancreatic cystadenoma and cystadenocarcinoma.Methods A retrospective clinicopathologic analysis was made on 17 cases of pancreatic cystadenoma and cystadenocarcinoma admitted from June 1996 to March 2007.Results Pancreatic cystic neoplasms had no specific clinical features. Ultrasonography and CT can be used to discover tumor ,but they can not be used for tumor differentiation.Tumor enucleation was performed in 7 cases of serous cystadenomas; for 6 cases of mucinous cystadenoma,pancreaticoduodenectomy was performed in 1 case,and resection of body and tail resection of pancreas in 5 cases. Four cases of cystadenocarcinoma were treated by pancreaticoduodenectomy plus lymphadenectomy in 1 case,resection of body and tail of pancreas in 2 cases, and resection of body and tail of pancreas plus splenectomy in 1 case. Fifteen cases were followed up with a median period of 42(1-129) months and without tumor recurrence.One elderly patient with cystadenocarcinoma who underwent resection of body and tail of pancreas plus splenectomy died 6 months after operation. Others had survived and without tumor recurrence on ultrasound exam, but one had diabetes mellitus.Conclusions Ultrasonography and CT scan are helpul in the diagnosis of pancreatic cystic neoplasms. Increase in the knowledge of the clinicopathologic features of this disease is the key to improve the level of diagnosis and treatment.Surgical resection gives good therapeutic results.