胰腺浆液性囊腺瘤的诊断和治疗

目的 探讨胰腺浆液性囊腺瘤的诊断和治疗.方法 对1995年6月至2005年6月复旦大学附属中山医院收治的16例胰腺浆液性囊腺瘤病人的临床资料进行回顾性分析.结果 胰腺浆液性囊腺瘤好发于女性,无特征性临床表现.B超和CT诊断正确率分别为44%（7/16）和50%（8/16）.本组16例均行手术治疗,其中,胰十二指肠切除术8例,远端胰腺切除术3例,胰腺节段切除术2例,肿瘤摘除术3例,胰瘘是主要的并发症.本组13例获随访,3例失访.3例因其它疾病死亡,其余均健在,术后无复发.结论 B超和CT是胰腺浆液性囊腺瘤主要的影像学检查方法,但准确率不高.有症状的胰腺浆液性囊腺瘤,或与黏液性囊性肿瘤不能鉴别的,应手术治疗.手术可行非根治性的胰腺切除术,甚至肿瘤摘除术.浆液性囊腺瘤手术切除后即可治愈.     

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。     

胰腺囊性肿瘤的诊治98例报告

目的探讨胰腺囊性肿瘤的常见类型、诊断及合理手术方式的选择。方法对2000年1月至2008年12月期间收治98例胰腺囊性肿瘤患者的临床资料进行回顾性分析。结果本病无特征性的临床表现,B超、CT和Mill等影像学检查也能发现胰腺囊肿病灶但不能确定具体类型。本组胰腺囊腺瘤57例（浆液性囊腺瘤32例,黏液性囊腺瘤25例）,黏液性囊腺癌13例,实性假乳头状瘤19例,导管内乳头状黏液性肿瘤9例。所有患者均手术治疗,胰十二指肠切除26例,保留十二指肠胰头切除28例,胰腺节段切除术7例,胰体尾切除加脾脏切除25例,肿瘤摘除术12例。术后均进行随访,3例胰腺囊腺癌患者于术后6个月到4年期间死于癌转移或其他疾病,1例囊腺癌患者术后9个月肿瘤复发,再次手术后现仍生存,其他均存活。结论B超,CT和MRI等影像学技术是胰腺囊性肿瘤的主要诊断方法。手术切除为治疗该肿瘤的最有效手段。正确的诊断和合理手术方式的选择是提高其临床治愈率的关键。     

胰腺囊性肿瘤13例诊治体会

目的 探讨胰腺囊性肿瘤的诊断与治疗方法.方法 对13例胰腺囊性肿瘤患者的临床资料进行回顾性分析.结果 浆液性囊腺瘤4例,黏液性囊腺瘤7例,黏液性囊腺癌2例.B超和CT诊断胰腺囊性肿瘤的正确率分别为85%(11/13)和92%(12/13).采取胰十二指肠切除术6例,胰体尾部切除3例,胰腺局部切除3例,囊壁大部切除1例....     

胰腺囊腺瘤和囊腺癌的临床病理特点及诊治体会

目的探讨胰腺囊腺瘤和囊腺癌的临床病理特点及其诊治方法。方法回顾性分析1996年6月—2007年3月收治的17例患者的临床病理资料。结果全组临床表现无特征性。B超和CT检查能发现囊肿但不能确定类型。浆液性囊腺瘤7例均行肿瘤局部切除,黏液性囊腺瘤6例行胰十二指肠切除1例,胰体尾切除5例;囊腺癌4例行胰十二指肠切除加淋巴结清扫1例,胰体尾切除术2例,胰体尾加脾切除1例。病理标本多呈多房囊腔,囊腔与胰管不通。15例获得随访,中位随访时间43(1～129)个月,1例囊腺癌行胰体尾加脾切除的老年患者术后6个月营养不良衰竭死亡;其余患者均生存,经B超检查均未见肿瘤复发,仅1例胰十二指肠切除术后患者出现糖尿病,疗效满意。结论B超和CT是该病的主要影像检查方法。加强对该病临床病理特征的认识是提高诊治率的关键,手术切除治疗疗效满意。     

胰腺囊性肿瘤的诊治研究

目的 初步探讨胰腺囊性肿瘤的诊治策略.方法 回顾性分析我院近十年来收治的21例胰腺囊性肿瘤的病例资料.结果 21例胰腺囊性肿瘤患者中胰腺浆液性囊腺瘤11例,黏液性囊腺瘤6例,胰腺导管内乳头状黏液性肿瘤2例,胰腺实性假乳头状瘤2例;其中仅7例患者伴有相应的症状和体征,其他均为健康体检时所发现.所有患者均经手术治疗,其中8例行胰十二指肠切除术、5例行胰体尾切除术、1例行腹腔镜下胰尾切除术、2例行胰腺肿瘤摘除术、4例行胰腺节段切除术;1例囊腺癌患者仅可行姑息手术,其余20例患者随访11～96个月,均未出现肿瘤复发或转移.结论 任何影像学检查都不能准确判断胰腺囊性肿瘤的具体病理类型;及时手术探查是防止肿瘤癌变的重要手段,除了已经获得明确诊断、肿瘤较小且无明显症状的浆液性囊腺瘤之外,都应该积极手术治疗.     

胰腺囊性肿瘤的诊治分析

目的 探讨胰腺囊性肿瘤的合理手术方式及术后并发症的处理.方法 对1997年1月至2009年12月收治的32例胰腺囊性肿瘤患者的临床资料进行回顾性分析,男性6例,女性26例,年龄24～76岁.胰腺浆液性囊腺瘤16例;胰腺黏液性囊腺瘤9例,其中1例为黏液性囊腺癌;胰腺导管内乳头状黏液性肿瘤4例;胰腺实性假乳头状瘤3例.肿瘤位于胰头颈部12例,位于胰体尾部20例.结果 所有患者均经手术治疗,无围手术期死亡;10例行胰十二指肠切除术、1例行保留十二指肠胰头切除术、13例行胰体尾切除术(其中2例行腹腔镜下胰体尾切除术)、3例行胰腺肿瘤摘除术、4例行胰腺中段切除术;1例囊腺癌患者仅行姑息手术.术后发生胃瘫3例、胰瘘5例,均经保守治疗痊愈.全组29例患者获得随访,随访时间4个月～10年,3例患者于术后4～34个月分别死于癌转移或其他疾病,其余26例患者均存活,且未发现肿瘤复发或转移.结论 胰腺囊性肿瘤术前应首选无创的CT检查,及时手术探查是防止肿瘤癌变的重要手段;具体的手术方式选择应按个体化原则,并应遵循损伤控制性手术原则;保留器官的手术方式更要重视术后胃瘫、胰瘘等并发症的处理.     

胰腺囊腺瘤和囊腺癌的临床病理特点及诊治体会

目的探讨胰腺囊腺瘤和囊腺癌的临床病理特点及其诊治。方法回顾性分析山东省菏泽市立医院及曹县人民医院1996年6月至2007年3月共收治的17例患者的临床病理资料。结果本病临床表现无特征性。B超和CT检查能发现囊肿但不能确定类型。浆液性囊腺瘤7例均行肿瘤局部切除;黏液性囊腺瘤6例,行胰十二指肠切除1例,胰体尾切除5例;囊腺癌4例,行胰十二指肠切除加淋巴结清扫1例,胰体尾切除术2例,胰体尾加脾切除1例。光镜下浆液性囊腺瘤囊壁由扁平或立方上皮细胞组成;黏液性囊腺瘤囊壁由高柱状上皮细胞组成,可见乳头状突起;囊腺癌囊壁细胞核异形明显,可见核分裂象及间质浸润。15例获得B超随访,中位随访时间为42个月（1～129个月）,除1例行胰体尾切除加脾切除的老年囊腺癌患者术后6个月死于营养衰竭和1例胰十二指肠切除患者并发糖尿病外,其余患者生存满意,未见肿瘤复发。结论B超和CT是本病的主要影像检查方法。加强对本病临床病理特征的认识是提高诊治率的关键。手术切除治疗本病疗效满意。     

胰腺囊性肿瘤24例诊治分析

目的探讨胰腺囊性肿瘤的诊断及治疗策略。方法回顾性分析本院1998至2011年收治的24例胰腺囊性肿瘤患者的诊治资料。结果所有患者均经手术治疗,其中浆液性囊腺瘤11例;粘液性囊腺瘤5例;囊腺癌5例;导管内乳头状粘液性肿瘤2例,其中恶性1例;实性假乳头状瘤1例。5例行胰十二指肠切除术,10例行胰腺体尾部切除术,7例行胰腺肿瘤切除术,2例术中发现腹腔内转移,仅行活检术。无围手术期死亡病例,22例获得随访,随访6个月～11年,死亡5例,存活17例。结论胰腺囊性肿瘤无特征性临床表现,B超、CT、CA19—9有助于诊断,提高对本病的认识,积极的手术切除是改善其预后的主要措施。     

胰腺浆液性囊腺肿瘤的临床诊断及治疗方法分析

目的研究分析胰腺浆液性囊腺肿瘤的临床诊断和治疗方法,以提高诊断率和治疗水平。方法选取我院从1997年10月至2013年1月收治的60例经病理证实的胰腺浆液性囊腺肿瘤患者作为研究对象,对其临床资料进行回顾性分析。结果 60例患者中,男性患者14例,占23.33%,女性患者46例,占76.67%;患者年龄24岁至88岁,平均年龄57.88±3.52岁。术前无明显临床症状患者20例,占33.33%。所有患者行B超检查,提示胰腺有囊性或囊实性占位者50例(83.33%),14例确诊为浆液性囊腺瘤(23.33%)。52例患者行CT检查,确诊浆液性囊腺瘤38例,诊断符合率为73.08%。所研究患者均采用手术治疗,其中行胰十二指肠切除术18例(30.00%),胰腺远端切除术40例(66.66%),肿瘤剥除术1例(1.67%),胃空肠,胆管空肠吻合术1例(1.67%)。术后有6例患者出现并发症(占10.00%),主要并发症有胰瘘,内出血,幽门梗阻,胰腺假性囊肿合并肠瘘及不同程度的胸腔积液。术后随访1至15年,除1例浆液性囊腺癌患者于术后14个月死亡外,其余预后良好,术后无复发。术后对肿瘤进行病理分型,分为微囊型浆液性囊腺瘤52例(占86.67%),寡囊型浆液性囊腺瘤8例(占13.33%),包括微囊型浆液性囊腺癌1例。寡囊型患者的术后平均住院日为(20.11±0.87)d大于微囊型(17.12±6.77)d,差异有统计学意义(P=0.030)。按肿瘤大小分为两组,直径≥4 cm组和直径4 cm组。肿瘤直径≥4 cm组患者临床症状发生率为76.56%高于直径-4 cm组临床症状发生率23.10%(P=0.021),其余临床指标经统计学处理无显著差异。结论胰腺浆液性囊腺瘤好发于中老年女性,无特异性临床表现。B超检查适用于初步诊断和筛查,CT诊断准确率较高,有重要临床诊断价值。肿瘤多发于胰体尾部,胰体尾切除术为主要手术方式。术后主要并发症为胰瘘。经手术治疗后,患者症状得到改善,远期预后较好。     

胰腺囊性肿瘤40例诊疗分析

目的探讨胰腺囊性肿瘤的诊治方法。方法对笔者所在医院科室2001年10月至2013年10月期间收治的40例胰腺囊性肿瘤患者的临床资料进行回顾性分析。结果胰腺囊性肿瘤无特殊临床表现,B超和CT检查对胰腺囊性肿瘤的诊断正确率分别为57．5％（23／40）和72．5％（29／40）,但不能准确区分其组织学类型。40例患者均行手术治疗,其中2例患者误诊为假性囊肿而行内引流术,另外38例行胰体尾切除术。术后病理学检查证实浆液性囊腺瘤23例,黏液性囊腺瘤9例,导管内乳头状黏液性腺瘤3例,黏液性囊腺癌5例。5例失访,35例患者获随访,随访时间为（74．2±12．8）个月（2个月～8年）;3例囊腺癌患者中1例肿瘤切除者至今存活（已随访8年）,2例肿瘤未切除者分别于术后4个月和7个月因肿瘤转移死亡;其余32例获访的囊腺瘤患者均存活至今。结论外科切除是治疗胰腺囊性肿瘤最有效的手段,即使是对于无任何症状的患者也应行积极的手术治疗。     

36例胰腺浆液性囊腺瘤的临床分析

目的：探讨胰腺浆液性囊腺瘤的诊断和治疗。方法：对1998年6月至2006年9月瑞金医院收治的36例病理诊断为胰腺浆液性囊腺瘤的临床资料进行回顾性分析。结果：胰腺浆液性囊腺瘤好发于中老年女性,多见于胰腺头颈部,无特征性临床表现。B超和CT诊断囊性肿瘤的正确率分别为69%（25/36）和94%（34/36）。CT对于囊腺瘤的诊断正确率为80%（29/36）,对浆液性囊腺瘤的诊断正确率为61%（22/36）。在不能排除或考虑实性假乳头状瘤的病人中MRI对于囊腺瘤的诊断正确率80%（4/5）。本组35例行手术治疗,其中7例行胰十二指肠切除;11例行胰腺节段切除;12例行胰体尾切除;5例行局部切除,1例行剖腹探查活组织检查。10例术后出现并发症,包括胰瘘、内出血、幽门梗阻、胰腺假性囊肿合并肠瘘病人及不同程度的胸腔积液。1例因内出血死亡。本组3例失访,32例获随访,除2例因其它疾病死亡,其余均健在,术后无复发。结论：CT和MRI,结合肿瘤学指标和临床病理特征可大大提高浆液性囊腺瘤的术前诊断率。浆液性囊腺瘤是一种良性的肿瘤,但手术治疗并发症较多。大多数浆液性囊腺瘤可考虑随访;有症状的胰腺浆液性囊腺瘤,或与黏液性囊性肿瘤不能鉴别者,应手术治疗。     

Cystic pancreatic neuroendocrine tumors: Is preoperative diagnosis possible?

Pancreatic neuroendocrine tumors rarely undergo cystic degeneration leading to a radiologic appearance, which is often interpreted as a pancreatic mucinous cystadenoma or pseudocyst. We reviewed our experience with 38 neuroendocrine tumors, four of which were cystic, and 24 other cystic pancreatic tumors (mucinous cystadenoma [n = 5], cystadenocarcinoma [n = 6], serous cystadenoma [n = 3], solid/cystic papillary neoplasm [n = 3], intraductal papillary mucinous tumor [n = 6], and mucinous adenocarcinoma [n = 1]) managed operatively between 1990 and 2000. This review was undertaken to identify clinical and pathologic features useful for preoperative diagnosis of cystic neuroendocrine tumors. Two of the four patients with cystic neuroendocrine tumors presented with abdominal pain, one patient was asymptomatic, and one patient had hypoglycemia. Three of the four cystic neuroendocrine tumors were identified by CT scan, and none were biopsied preoperatively. Preoperative diagnoses included mucinous cystadenoma in two patients (n = 2), pancreatic cystic neoplasm in one patient, (n = 1) and insulinoma in one patient (n = 1). All four cystic neuroendocrine tumors were benign and were completely resected (distal pancreatectomy [n = 2], enucleation [n = 2]). Cystic neuroendocrine tumors are difficult to diagnose preoperatively because the majority of these tumors are nonfunctional, and CT does not differentiate these tumors from other cystic neoplasms. Cystic neuroendocrine tumors represent a subgroup of pancreatic cystic and neuroendocrine tumors with malignant potential. Their high resectability rate further supports the role of surgical exploration and resection in the treatment of pancreatic cystic neoplasms. Presented at the Third Americas Hepatopancreatobiliary Congress, Miami, Fla., February 22–25, 2001.     

Cystic neoplasms of the pancreas – cystadenomas and cystadenocarcinomas

Introduction: Among the rare cystic pancreatic tumors, serous and mucinous cystadenoma and mucinous cystadenocarcinoma are most often diagnosed. Case: We report on a total of 21 patients with cystic neoplasms who underwent surgery, 11 of whom had mucinous cystadenocarcinoma. Of the 10 remaining patients, serous and mucinous cystadenoma were diagnosed in two groups of five. A common feature of all cystic neoplasms is slow growth, leading to clinical symptoms at an advanced stage, with tumors frequently becoming enormous. Results: In approximately half of the cases, diagnosis was possible by means of ultrasound, computed tomography and, in three instances, by preoperative percutaneous aspiration. Differential diagnosis of pseudocysts proved to be most difficult. Conclusion: Given the low operative risk, resection should always be performed in instances where findings cannot be clearly identified. Moreover, compared with ductal pancreatic carcinomas, the prognosis of a cystadenocarcinoma after early resection is extremely favorable, so that postponing resection might reduce the patient's prospects of being cured. Received: 24 April 1998 Accepted: 13 October 1998     

Cystic tumors of the pancreas. New clinical, radiologic, and pathologic observations in 67 patients.

Within a 12-year period we treated 67 patients (49 women, 18 men; mean age, 61 years) with cystic neoplasms of the pancreas, including 18 serous cystic adenomas, 15 benign mucinous cystic neoplasms, 27 mucinous cystadenocarcinomas, 3 papillary cystic tumors, 2 cystic islet cell tumors, and 2 cases of mucinous ductal ectasia. Mean tumor size was 6 cm (2 to 16 cm). In 39% the patients had no symptoms, and in 37% the lesions had been misdiagnosed as a pseudocyst. Computed tomography was useful for detection, for distinguishing the microcystic subgroup of serous cystadenoma, and for showing rim calcification (all 7 cases were malignant) but was not reliable for distinguishing neoplasm from pseudocyst, serous from mucinous tumors, or benign from malignant. Arteriography showed hypervascularity in 4 of 10 serous adenomas, 3 of 11 mucinous carcinomas, and 1 of 1 papillary cystic tumors. Endoscopic pancreatography showed no communication with the cyst cavity in 37 of 37 cases of cystic neoplasms but opacified the ectatic ducts in 2 of 2 cases of mucinous ductal ectasia. Stenosis or obstruction of the pancreatic duct indicated cancer. The tumor was resected by distal pancreatectomy in 25 patients, by proximal resection in 29, and by total pancreatectomy in one, with no operative deaths. Forty-four per cent of the tumors were malignant. In 10 cases the tumor was unresectable because of local extension or distant metastases, and those patients died at a mean of 4 months. Seventy-five per cent of those resected for cure are alive without evident recurrence. Because the epithelial lining of the tumor was partially (5% to 98%) absent in 40% to 72% of cases of the major tumor types, and the mucinous component comprised only about 65% of mucinous cystadenoma lining, misdiagnoses on frozen and even permanent sections were made. Mitoses and histologic solid growth correlated with malignancy. Neuroendocrine elements were seen in 87% of benign and 47% of malignant mucinous tumors. It is recommended that the terms macrocystic and microcystic be abandoned in favor of the histologic designations serous and mucinous. Incomplete examination of the cyst wall can be misleading, however. It is suggested that mucinous ductal ectasia be recognized separately from cystic tumors and that all of these lesions be resected, with the possible exception of asymptomatic confirmed serous cystadenomas.     

Cystic tumors of the pancreas: preoperative imaging,diagnosis, and treatment

The objective of this retrospective study was to explore the accuracy of preoperative diagnostic methods and the efficacy of treatment for cystic pancreatic tumors. From 1989 to 1999, 18 patients underwent surgery for cystic tumor of the pancreas, classified as follows: one serous cystadenoma, eight mucinous cystadenomas, six mucinous cystadenocarcinomas, and three nonfunctioning islet cell tumors. Computed tomography (CT), endoscopic retrograde cholangiopancreatography (ERCP), and fine needle aspiration were performed and subsequently reviewed retrospectively by two radiologists. Three patients underwent the Whipple procedure and 14 and 1 patients underwent distal and central pancreatectomy, respectively. CT showed cystic pancreatic tumors in all cases. One case was misdiagnosed as a pseudocyst. The diagnosis was accurate in 82%, 53%, 37%, and 60% of cases on CT, ERCP, and angiography, and in the cytologic analysis of the aspirated fluid, respectively. All operative procedures were performed without significant morbidity and there were no postoperative deaths. Preoperative diagnosis of cystic pancreatic tumours is imprecise. CT is the most reliable preoperative imaging method. Resection should be the treatment of choice for these lesions, except in cases of serous cystadenoma.