胰腺囊性肿瘤26例临床诊治分析

目的探讨胰腺囊性肿瘤的诊断和治疗。方法对2000年6月至2005年6月复旦大学附属中山医院收治的26例胰腺囊性肿瘤的临床资料进行回顾性分析。结果B超和CT对胰腺囊性肿瘤的诊断正确率分别为88%(23/26)和92%(24/26),但不能准确区分其组织类型。26例均行手术治疗并获随访,1例黏液性囊腺癌病人因复发转移于术后11个月死亡,其余均存活,无复发。结论伴有症状的胰腺浆液性囊腺瘤,以及黏液性囊性肿瘤及导管内乳头状黏液性肿瘤因有恶变倾向及临床不能鉴别其良恶性,需手术治疗;而无症状的浆液性囊腺瘤可观察随访。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 cystic neoplasms of the pancreas:a report of 26 cases

Objective To investigate the diagnosis and treatment of cystic neoplasms of the pancreas.Methods Retrospective analysis was made on the clinical data of 26 cases of cystic neoplasms of the pancreas from June 2000 to June 2005.Results Cystic neoplasms of the pancreas occur predominately in women.Presenting symptoms are often vague and nonspecific.Ultrasonography and computed tomography(CT) displayed a cystic tumor in 88% and 92% of all patients,respectively,but the accurate differentiation may be difficult.Of the 26 cases,pancreaticoduodenectomy and distal pancreatectomy were performed in 11 respectively,middle segment pancreatectomy in 1,enucleation in 3.Postoperative pancreatic fistula was the leading complication.All the patients were followed up.One case of mucinous cystadenocacinoma died of recurrence and metastasis 11 months after operation.The others are still alive now with no evidence of recurrence.Conclusion Ultrasonography and CT scan are helpful in the diagnosis of pancreatic cystic neoplasms.Surgical resection is indicated for the symptomatic serous cytadenomas,and for the mucinous cystic neoplasms and intraductal papillary mucinous tumors because of their malignant tendency or difficult differentiation preoperatively between cystadenomas and cystadenocarcinomas,while asymptomatic patients with serous cytadenoma could be followed with serial imaging and managed nonoperatively.Surgical modality varies with the type(and even subtype) of cystic neoplasms of the pancreas.When the neoplasm is completely resected,the pancreatic cystadenoma is curative,and the outcome of the pancreatic cystadenocarcinoma is also satisfactory.