儿童胰腺肿瘤精准手术切除策略探讨(附15例报告)

目的 探讨影响小儿胰腺肿瘤手术切除方式的因素及精准手术切除的可行性.方法 回顾性分析2002年10月至2013年7月收治的儿童胰腺肿瘤15例的临床资料.15例中,女10例,男5例;年龄4个月～14岁,平均8岁4个月.肿瘤位于胰头部9例,胰体尾部6例,伴肝转移1例,合并肝、肠系膜病变1例.结果 本组均接受手术治疗.肿瘤位于胰腺头部9例行保留幽门、胰十二指肠切除术7例,行肿瘤切除术2例,此2例肿瘤均来源于胰头钩突部;肿瘤位于胰腺体尾部6例,均行胰体/尾+脾切除术.病理检查报告:胰腺囊实性假乳头状瘤9例,胰腺母细胞瘤3例,浆液性囊腺瘤1例,胰岛细胞癌1例,促纤维增生性小圆细胞瘤1例.15例患儿术后恢复顺利,随访6个月～12年,促纤维增生性小圆细胞瘤1例患儿死亡,余者均存活.结论 手术切除肿瘤是治疗儿童胰腺肿瘤得重要手段,多数患儿仅通过手术切除肿瘤可长期存活.手术原则是尽可能保持胃肠道连续性,精准手术,尽可能多的保留正常的胰腺组织.影响决定小儿胰腺肿瘤术式的主要因素是肿瘤部位、周围重要组织是否受累肿瘤是否累及胆管、主胰管及脾血管.CT、MRCP属非侵袭性检查方法,可多平面分析,且无需注射造影剂,可对胆管及胰管状况肿瘤进行术前评估,为胰腺肿瘤确定精准手术方案提供依据.

Accurate resection of pediatric pancreatic tumors: a report of 15 cases

Objective To explore the influencing factors for pediatric surgical resection of pancreatic tumor and examine the feasibility of accurate surgical resection.Methods Retrospective analyses of clinical data were conducted for 15 cases of pediatric pancreatic tumors from October 2002 to July 2013.There were 10 girls and 5 boys with a mean age of 100 (4-168) months.The lesion sites were pancreatic head (n =9),pancreatic body & tail (n =6),hepatic metastasis (n =1) and hepatic & mesenteric (n =1).Results The surgical procedures included pylorus-preserving pancreaticoduodenectomy (n =7),resection of pancreatic tumors derived from protruding hook (n =2) and resection of pancreatic body/tail plus splenectomy (n =6).Pathological types were pancreatic cystic false papilloma (n =9),pancreatic blastoma (n =3),serous (n =1),islet cell carcinoma (n =1) and desmoplastic small round cell tumor (n =1).After successful surgery,all children recovered well during a follow-up period of 6 months to 12 years.Except for 1 child dying from desmoplastic small round cell tumor,the remainder survived.Conclusions Surgical removal of tumor is essential for treating pediatric pancreatic tumors.Most pancreatic tumor children may obtain long-term survival only by surgical removal.The operative principles are maintaining the continuity of gastrointestinal tract and performing accurate surgery as much as possible to retain normal pancreatic tissue.The major influencing factors for surgical approaches of pediatric pancreatic tumors are tumor location and whether or not there are violations of surrounding tissue,bile duct,common pancreatic duct and splenic blood vessels.The examinations of CT and MRCP are standard for offering preoperative assessments of bile duct and pancreatic duct and determining accurate operation modes.