胰腺黏液性囊腺瘤和囊腺癌23例分析

目的探讨胰腺黏液性囊腺瘤和囊腺癌的诊断和治疗。方法对我院1993年5月~2005年10月收治的均经病理证实为胰腺黏液性囊腺瘤和囊腺癌患者23例临床特点和治疗结果进行回顾性分析。结果本组胰腺黏液性囊腺瘤15例、黏液性囊腺癌4例、黏液性囊腺瘤癌变4例。B超、CT和MRI/MRCP诊断正确率分别为73.7%、68.8%和83.3%。肿瘤平均长径为9.4cm,最大长径为20cm。根据肿瘤部位分别行胰十二指肠切除术、胰体尾切除 脾脏切除术、囊腺瘤单纯切除术等术式,手术切除率为82.6%。随访21例(随访率为91.3%),黏液性囊腺瘤14例,均健在,随访时间4月~11年。黏液性囊腺瘤癌变2例健在,随访时间分别为5月和4年,另2例死亡,术后生存时间分别为15月和18月。黏液性囊腺癌1例随访5月健在,2例死亡,术后存活分别为7月和13月。结论黏液性囊腺瘤有潜在恶性倾向。囊腺癌属低度恶性,手术切除率髙,切除预后好。手术应尽量保证肿瘤完整切除,切除范围应包括所在部位的部分胰腺,根据肿瘤部位可选择胰十二指肠切除或胰体尾切除等术式。

Clinicopathologic Study of 23 Patients with Mucinous Cystadenoma or Cystadenocarcinoma of the Pancreas

Objective To investigate the diagnosis and treatment of mucinous cystadenoma and cystadenocarcinoma of the pancreas. Methods The clinical data of 23 patients with pancreatic mucinous cystadenoma or cystadenocarcinoma confirmed by pathology from May 1993 to October 2005 was retrospectively studied. Results Fifteen cases of mucinous cystadenoma, 4 cases of mucinous cystadenocarcinoma, and 4 cases of mucinous cystadenoma with malignancy were included in this data. Ultrasonography, CT, and MRI/MRCP displayed a cystic tumor in 73.7%, 68.8%, and 83.3% of all patients, respectively. The mean diameter of the tumors was 9.4 cm, and the maximum diameter of the tumors was 20 cm. Pancreaticoduodenectomy, distal pancreatectomy and splenectomy, local excision of cystadenoma and other procedures were performed according to the site of tumors. The resectable rate was 82.6%. Twenty-one patients (91.3%) were followed up. All of the 14 patients with mucinous cystadenoma were alive with the follow-up from 4 months to 11 years after operation. Two of the 4 cases of mucinous cystadenoma with malignancy were alive with the follow-up of 5 months and 4 years after operations, while the other 2 died with the survival time of 15 months and 18 months. One patient with mucinous cystadenocacinoma was alive 5 months after operation, while the other 2 died with the survival time of 7 months and 13 months. Conclusion Mucinous cystadenoma has a malignant tendency. As the mucinous cystadenocacinoma is a low malignant potential tumor, the resectable rate is high and prognosis is satisfactory. The excision of total tumor including the surrounding pancreatic tissue is the first choice of the treatment. Pancreaticoduodenectomy, distal pancreatectomy and splenectomy, and other procedures according to the site tumors is feasible.