中国普外基础与临床杂志

中国普外基础与临床杂志

胰腺实性假乳头状瘤的特点及诊疗分析

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目的 分析胰腺实性假乳头状瘤(SPN)的临床特点并探讨其诊断及治疗方法。 方法 回顾性收集新疆医科大学第一附属医院 2012 年 1 月至 2017 年 7 月期间收治的经病理学检查证实的 39 例胰腺 SPN 患者的临床病理资料,分析其临床特征、影像学特征、治疗方式及预后。 结果 39 例患者中良性 SPN 27 例,恶性 SPN 12 例,良、恶性 SPN 患者的性别、年龄、血型和临床表现比较差异并无统计学意义(P>0.050)。良性和恶性 SPN 患者的肿瘤部位分布(P=0.063)及形态学特点(P=0.943)比较差异均无统计学意义,二者在合并钙化、囊内出血及胰管扩张发生比例方面比较差异也无统计学意义(P>0.050)。良性和恶性 SPN 患者的肿瘤最大直径、包膜是否完整以及肿瘤囊实性比例比较差异均有统计学意义(P<0.050),即良性 SPN 患者的肿瘤最大直径≤5 cm 者居多、包膜完整、偏实性。27 例良性 SPN 患者中,行肿瘤剜除术 6 例,行标准胰十二指肠切除术 7 例,行胰腺中段切除术 2 例,行标准胰体尾切除术 5 例,行保留脾脏胰体尾切除术 7 例。12例恶性 SPN 患者中 8 例行标准胰十二指肠切除术,4 例行标准胰体尾切除术。所有患者术后均好转出院,均未发生腹腔感染,4 例患者术后出现胰瘘,经积极而充分的引流后好转。随访截止时间至 2017 年 8 月 31 日,平均 24.5 个月,无肿瘤转移或复发患者,无死亡患者。 结论 胰腺 SPN 若出现包膜不完整、肿瘤最大直径>5 cm 提示肿瘤可能为恶性;肿瘤成分偏实性可能提示为良性;手术是治疗胰腺 SPN 首要有效的方法,恶性 SPN 建议常规行根治术。

Objective To analyze characteristics of solid pseudopapillary neoplasm (SPN) of pancreas and to discuss it’s diagnosis and treatment. Methods The clinicopathologic data of 39 patients with pathologically diagnosed as SPN from January 2012 to July 2017 in the First Affiliated Hospital to Xinjiang Medical University were collected, the clinical characteristics, imaging features, diagnosis and treatment methods, and prognosis were analyzed. Results Among the 39 patients, there were 27 benign SPNs and 12 malignant SPNs. There were no significant differences in the gender, age, blood type, clinical manifestations, distribution of tumor sites, morphological features, and proportions of combined calcification, intracapsular hemorrhage, and pancreatic ductal dilatation between the benign and malignant SPN patients (P>0.050). The maximum diameter of the tumor, the integrity of the capsule, and the ratio of the tumor cystic solidity had significant differences (P<0.050) between the benign and malignant SPN patients. That was, in patients with benign SPN, the largest tumor diameter was less than or equal to 5 cm, and the capsule was complete, and the tumor was mainly cystic and solid. Of the 27 patients with benign SPN, 6 underwent the tumor enucleation, 7 underwent the standard pancreatoduodenectomy, 2 underwent the middle pancreas resection, 5 underwent the standard caudal pancreatectomy, and 7 underwent the spleen-preserving caudal pancreatectomy. Of the 12 patients with malignant SPN, 8 underwent the standard pancreatoduodenectomy and 4 underwent the standard caudal pancreatectomy. All the patients were discharged after surgery and no intra-abdominal infection occurred. The pancreatic leakage occurred in 4 patients and recoved after the full drainage. The average follow-up was 24.5 months, no patient had the tumor metastasis or recurrence, and no patient died. Conclusions Incomplete capsule and the largest diameter >5 cm may suggest malignancy of SPN, and near-solid tumors may be indicative of benignancy. Surgery is a crucial and most effective treatment for SPN, and it is suggested that routine radical operation is performed for malignant SPN.

关键词: 胰腺实性假乳头状瘤; 恶性潜能; 手术

Key words: pancreas solid pseudopapillary neoplasm; malignant potential; surgical operation

引用本文: 朱时雨, 许新才, 程坤, 苏力担卡扎·仇曼, 陈启龙, 林海. 胰腺实性假乳头状瘤的特点及诊疗分析. 中国普外基础与临床杂志, 2018, 25(7): 825-831. doi: 10.7507/1007-9424.201712053 复制

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