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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。
Objective: To investigate the diagnosis and treatment of pancreatic serous cystadenoma. Methods: The clinical data of 36 cases with pancreatic serous cystadenoma diagnosed in Ruijin Hospital from June 1998 to September 2006 were analyzed retrospectively. Results: Pancreatic serous cystadenoma occurred in middle-aged and elderly women, more common in the head and neck of the pancreas, no clinical manifestations. The correct rates of B-ultrasound and CT diagnosis of cystic tumors were 69% (25/36) and 94% (34/36), respectively. The diagnostic accuracy of CT for cystadenoma was 80% (29/36), and the diagnosis of serous cystadenoma was 61% (22/36). Among patients who can not rule out or consider a solid pseudopapillary tumor, the diagnosis of cystadenoma is correct by 80% (4/5). The group of 35 patients underwent surgical treatment, of which 7 cases of pancreatoduodenectomy; 11 cases of pancreatic segmentectomy; 12 cases of pancreatic body tail resection; 5 cases of local excision, 1 case of laparotomy biopsy. Ten cases had postoperative complications, including pancreatic fistula, internal hemorrhage, pyloric obstruction, pancreatic pseudocyst with intestinal fistula and different degrees of pleural effusion. One died of internal bleeding. Three patients in this group were lost to follow-up, and 32 patients were followed up. Except 2 patients died due to other diseases, the rest were all alive without recurrence. Conclusion: CT and MRI combined with oncology and clinicopathological features can greatly improve the preoperative diagnosis rate of serous cystadenoma. Serous cystadenoma is a benign tumor, but the surgical treatment of complications more. Most serous cystadenomas may be considered for follow-up; symptomatic pancreatic serous cystadenomas, or those with mucinous cystic tumors that can not be identified, should be surgically treated.