38例胰腺囊性肿瘤的临床诊断及外科治疗

目的探讨胰腺囊腺瘤、囊腺癌的诊断和治疗方法.方法对1980年1月～2005年4月中国医科大学附属第一医院收治的38例胰腺囊腺瘤和囊腺癌患者的临床表现、检查、手术方式及预后进行了分析.结果胰腺囊腺瘤、囊腺癌主要发生在胰体尾部（79%）,女性多见（84%）,肿瘤无特异性临床表现.超声和CT是主要的影像学检查方法,本组病例超声的诊断率为66%,CT为78%,血清肿瘤标志物检查对诊断意义不大.38例胰腺囊腺瘤、囊腺癌中行胰十二指肠切除2例,保留十二指肠的胰头切除1例,胰体部分切除1例,胰体尾切除21例,肿瘤摘除8例.手术切除的28例胰腺囊腺瘤中25例获得随访,2例因其他疾病死亡,23例健在.8例胰腺囊腺癌手术切除5例,4例获得随访,3例存活.手术后胰瘘的发生率为28%.结论胰腺囊腺瘤手术切除后可以达到治愈,囊腺癌切除后也有较高的生存率.术中病理检查是术式选择的关键,对于诊断明确的良性肿瘤可行胰腺局部切除术,或行肿瘤摘除术.

Diagnosis and surgical treatment of pancreatic cystadenoma and cystadenocarcinoma in 38 cases

Objective To investigate the diagnosis and treatment of pancreatic cystadenoma and cystadenocarcinoma. Methods From Jan 1980 to April 2005, 38 cases of pancreatic cystadenoma and cystadeonocarcinoma were admitted. Clinical manifestation, chemical test, operation types and prognosis were analyzed. Results pancreatic cystadenoma and cystadenocarcinoma were mainly located in the body and tail of the pancreas (79% ) , female accounted for 84%. No specific clinical features were indentified. Ultrasound and CT were main image examinations with correct diagnosing rates of 66% and 78% respectively; serum tumor markers were not helpful. Two patients underwent pancreaticoduodenectomy, 1 underwent resection of the head of the pancreas with duodenum preservation, one underwent local resection of the body of the pancreas, 21 underwent resection of the body and tail of the pancreas, eight underwent tumor excision. Twenty five out of 28 cases of pancreatic cystadenoma receiving resection were followed up, with 2 dying of unrelated diseases and 23 alive. Five out of 8 cases of pancreatic cystadenocarcinoma underwent resection, postoperative 4 cases were followed up with 3 being alive. Postoperative pancreatic fistula occurred in 28%. Conclusions Cystadenoma of the pancreas is surgically curable. The prognosis of postoperative cystadenocarcinoma is satisfactory. Intraoperative histology study is crucial in the selection of operation types. For identified benign pancreatic adenoma, segmental pancreatectomy is the treatment of choice. For some cases, it is rational to do tumor enucleation.