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。

Diagnosis and treatment of the pancreatic cystadenoma and cystadenocarcinoma

Objective-To investigate the diagnosis and treatment of the pancreatic cystadenoma and cystadenocarcinoma.Methods Retrospective analysis was made on the clinical data of 24 cases of pancreatic cystic neoplasms from June 2000 to June 2005.Results Pancreatic cystic neoplasms had no specific clinical features.Ultrasonography and CT diagnosed correctly in 88% and 92% of all patients respectively,but they could not be used for tumor differentiation.Three cases of serous cystadenomas were kept on watchful observation,21 patients were treated surgically.Pancreaticoduedenectomy was performed in 9 cases,distal pancreatectomy in 8,segmental pancreatectomy in 1,tumor enucleation in 3.Postoperative pancreatic fistula was the main complication.All the patients were followed up.The serous cystadenoma in the 3 patients was stable without significant increase in the diameter,1 case of mucinous cystadenocacinoma died of recurrence and metastasis 11 months after operation,and all others were currently alive with no evidence of recurrence.Conclusions Ultrasonography and CT scan are helpful in the diagnosis of pancreatic cystic neoplasms.Surgical resection is indicated for the mucinous cystic neoplasms and the symptomatic serous cytadenomas.When the neoplasm is completely resected,the pancreatic cystadenoma is curative,and the outcome of the pancreatic cystadenocarcinoma is also satisfactory.