胰腺囊性肿瘤的诊断和治疗

目的：探讨胰腺囊腺瘤和囊腺癌的诊断和治疗。方法：回顾性分析近6年收治的均经手术和病理检查证实的30例胰腺囊性肿瘤患者的临床资料。结果：胰腺囊性肿瘤好发于中青年女性,临床表现多为病程较长的上腹部肿物和胀痛。B超、CT及ERCP等能协助诊断。全组手术切除率为80.0%（良性肿瘤100%，恶性肿瘤70.0%）。肿瘤位于头颈部者7例中行胰十二指肠切除3例、保留十二指肠及少量胰头的胰腺近全切除1例、胰腺节段切除2例、胰颈肿瘤摘除1例;位于胰体尾者17例中行肿物摘除1例、胰体切除4例、胰体尾切除及脾切除11例、胰节段切除及胰空肠Roux-en-y吻合1例;6例广泛转移者仅行活检及姑息手术。术后主要并发症为胰瘘( 20%) ，均治愈。无手术死亡。结论：胰腺囊腺瘤和囊腺癌无特征性临床表现，主要依据上腹部肿物及影像学检查(超声、CT) 来发现。其手术切除率较高，预后较好，应采取积极的外科治疗，首选手术方式为包括部分胰腺组织的全肿瘤切除。

The diagnosis and the treatment of the cystic neoplasm of pancreas

Objective To study the diagnosis and treatment of the cystic neoplasms of pancreas(CNP).Methods The clinical data of 30 cases of CNP,with comfirmed by pathology,admitted in our hospital in recent 6 years were retrospective analyzed.Results CNP was more seen in mid-young women.The course of CNP was longer.Upper abdominal mass and abdminal distention and pain were the main clinical(presentations).Ultrasounography,CT and ERCP could be help to the diagnosis of CNP.The CNP resection rate was 80%(in bengin CNP was 100%,in malignant CNP was 70.0%).Of the 7 patients with CNP located at head and neck of pancreas,pancreaticoduodenectomy was performed in 3 patients,near total(resection) of pancreas pancreas with preserving the duodenum in and small part of the head of pancreas 1,(segmental) resection of the pancreas in 2,and extraction of the tumor in 1.Among the 17 patients with CNP located at body and tail,resection of the body and tail with or wothout splenectomy in 15 patients,tumor(extraction) in 1,pancreas segmental resection with Roux-en-y pancreticojejunostomy in 1.The other 6 patients with diffused CNP were unresectable.The main operative complication was pancreatic fistula(20.0%);all the fistula was cured No death occurred in this series.Conclusions CNP have no clinical characteristics.The discovery of this disease is mainly according to the upper mass and imaging examination(ultrasound,CT etc).The resection rate of CNP is high,the prognosis is good.So that,aggressive surgery treatment must be adopted.Resection of the whole tumor with part paratumor pancreas tissue is advocated.