胰腺囊腺癌：附13例报告

目的:探讨胰腺囊腺癌的诊断和治疗策略。方法:回顾分析13例胰腺囊腺癌患者的临床资料。结果:症状以腹痛、腹胀最常见（12例）,4例上腹部扪及肿物, 病程1个月至5年,10例B超示多房囊性或者囊实性肿块,内部回声欠均匀;9例CT示胰腺囊性或囊实性病变,增强扫描后囊壁部分增强,2例囊壁钙化。肿瘤位于胰腺头颈部6例,胰体尾部5例,全胰腺2例,术前正确诊断仅2例（15.4％）,手术切除率76.9％(10/13),病死率为7.7％（1/13）。病理均示黏液性囊腺癌,1例术后因胰瘘死亡,随访8例,失访4例,存活10个月～10年。结论:胰腺囊腺癌的诊断困难,误诊率高,影像学结合CA15-3检查可提高诊断率;以积极手术为主的综合治疗有望取得较好的预后。

Pancreas cystadenocarcinoma: a report of thirteen cases

Objective To discuss the diagnosis and treatment strategy of cystadenocarcinoma of pancreas.Methods The clinical records of 13 cases of cystadenocarcinoma of pancreas were reviewed retrospectively.Results Twelve cases showed abdominal pain and distention, and an upper abdominal mass was palpated in 4 cases. The course of disease lasted from one month to five years. On B ultrasound examination, 10 cases showed multiple loculated cystic or cystic solid mass of pancreas, with non-homogeneous echo inside. CT scanning was done in 9 cases, it showed cystic and systic-solid lesion of pancreas and the enhanced image showed cyst wall with partial enhancement, and cyst wall calcified in two cases. Six cases of cystadenocarcinoma were located in the head and neck of pancreas, five in the body and tail, and two involved the whole pancreas. Correct preoperative diagnosis was made in two cases. The excision rate was 69%(10/13) and mortality rate 7.7%(1/13).All were mucinous cystadenocarcinoma pathologically. One patient died from pancreas fistula. Eight cases were followed up, but four were lost to followup. The survival time was ten months to ten years.Conclusions Correct diagnosis of cystadenocarcinoma of pancreas is rather difficult, and the rate of misdiagnosis is high.However, imaging and CA15-3 examination are helpful for diagnosis. With aggressive surgery and combined therapy, a better prognosis can be expected.