中华肝胆外科杂志
中華肝膽外科雜誌
중화간담외과잡지
CHINESE JOURNAL OF HEPATOBILIARY SURGERY
2010年
2期
92-95
,共4页
高红桥%杨尹默%庄岩%吴问汉%万远廉
高紅橋%楊尹默%莊巖%吳問漢%萬遠廉
고홍교%양윤묵%장암%오문한%만원렴
胰腺肿瘤%恶性%风险因素
胰腺腫瘤%噁性%風險因素
이선종류%악성%풍험인소
Pancreatic neoplasms%Malignancy%Predictive factor
目的 探讨胰腺囊性肿瘤病人术前症状、实验室检查、影像学特征及针吸活检在判断病变良恶性及对外科治疗的指导作用.方法 回顾性分析北京大学第一医院1994-2008年手术治疗的69例胰腺囊性肿瘤病人的临床资料,对性别、症状与体征、肿瘤部位、大小、肿瘤标记物、肿瘤实性成分、有否钙化及胰管梗阻等可能预测肿瘤恶性行为的风险因素进行统计学分析.结果 经术后病理证实,69例病人包括浆液性肿瘤13例,黏液性囊性肿瘤30例,胰管内乳头状黏液性肿瘤7例,实性假乳头状瘤12例,囊性内分泌肿瘤及其它肿瘤7例.69例中交界性或恶性44例,良性25例.单因素分析病人术前上述指标,显示梗阻性黄疸、血清CA19-9或CEA水平、肿瘤直径大于5 cm、囊性肿瘤实性成分与恶性病理关系密切,敏感性分别为34.1%(15/44)、47.7%(21/44)、88.6%(39/44)和72.7%(32/44),特异性为96%(24/25)、84%(23/25)、68%(17/25)和72%(18/25);多因素分析发现后三者为预测胰腺恶性囊性肿瘤的独立危险因素.9例病人行穿刺细胞学及囊内容物检查淀粉酶及CEA/CA19-9,其中3例明确恶性诊断.33例行术中冰冻病理,其中1例胰腺导管内乳头状黏液性癌切缘阳性改行全胰切除术.结论 综合评估术前无创检查资料,多能判断胰腺囊性肿瘤的良恶性进而指导临床治疗,术前穿刺活检适于良性可能性大并拟随诊观察者;术中行切缘病理检查可指导手术切除范围.
目的 探討胰腺囊性腫瘤病人術前癥狀、實驗室檢查、影像學特徵及針吸活檢在判斷病變良噁性及對外科治療的指導作用.方法 迴顧性分析北京大學第一醫院1994-2008年手術治療的69例胰腺囊性腫瘤病人的臨床資料,對性彆、癥狀與體徵、腫瘤部位、大小、腫瘤標記物、腫瘤實性成分、有否鈣化及胰管梗阻等可能預測腫瘤噁性行為的風險因素進行統計學分析.結果 經術後病理證實,69例病人包括漿液性腫瘤13例,黏液性囊性腫瘤30例,胰管內乳頭狀黏液性腫瘤7例,實性假乳頭狀瘤12例,囊性內分泌腫瘤及其它腫瘤7例.69例中交界性或噁性44例,良性25例.單因素分析病人術前上述指標,顯示梗阻性黃疸、血清CA19-9或CEA水平、腫瘤直徑大于5 cm、囊性腫瘤實性成分與噁性病理關繫密切,敏感性分彆為34.1%(15/44)、47.7%(21/44)、88.6%(39/44)和72.7%(32/44),特異性為96%(24/25)、84%(23/25)、68%(17/25)和72%(18/25);多因素分析髮現後三者為預測胰腺噁性囊性腫瘤的獨立危險因素.9例病人行穿刺細胞學及囊內容物檢查澱粉酶及CEA/CA19-9,其中3例明確噁性診斷.33例行術中冰凍病理,其中1例胰腺導管內乳頭狀黏液性癌切緣暘性改行全胰切除術.結論 綜閤評估術前無創檢查資料,多能判斷胰腺囊性腫瘤的良噁性進而指導臨床治療,術前穿刺活檢適于良性可能性大併擬隨診觀察者;術中行切緣病理檢查可指導手術切除範圍.
목적 탐토이선낭성종류병인술전증상、실험실검사、영상학특정급침흡활검재판단병변량악성급대외과치료적지도작용.방법 회고성분석북경대학제일의원1994-2008년수술치료적69례이선낭성종류병인적림상자료,대성별、증상여체정、종류부위、대소、종류표기물、종류실성성분、유부개화급이관경조등가능예측종류악성행위적풍험인소진행통계학분석.결과 경술후병리증실,69례병인포괄장액성종류13례,점액성낭성종류30례,이관내유두상점액성종류7례,실성가유두상류12례,낭성내분비종류급기타종류7례.69례중교계성혹악성44례,량성25례.단인소분석병인술전상술지표,현시경조성황달、혈청CA19-9혹CEA수평、종류직경대우5 cm、낭성종류실성성분여악성병리관계밀절,민감성분별위34.1%(15/44)、47.7%(21/44)、88.6%(39/44)화72.7%(32/44),특이성위96%(24/25)、84%(23/25)、68%(17/25)화72%(18/25);다인소분석발현후삼자위예측이선악성낭성종류적독립위험인소.9례병인행천자세포학급낭내용물검사정분매급CEA/CA19-9,기중3례명학악성진단.33례행술중빙동병리,기중1례이선도관내유두상점액성암절연양성개행전이절제술.결론 종합평고술전무창검사자료,다능판단이선낭성종류적량악성진이지도림상치료,술전천자활검괄우량성가능성대병의수진관찰자;술중행절연병리검사가지도수술절제범위.
Objective To determine the value of preoperative clinical, biochemical, cross-sec-tional imaging features and results of fine-needle aspiration for predicting malignancy in cystic neo-plasms of the pancreas (CNP). Methods The medical records of 69 patients receiving operations for CNP between 1994 and 2008 in our hospital were reviewed retrospectively. The predictive effect of va-rious preoperative factors such as sex, location, clinical manifestation, maximum diameters, tumor marker, pancreatic duct obstruction and calcification on the malignant potential of CNP was evaluated by Single and multi-factor analysis, fine needle aspiration (FNA) and intraoperative frozen-section ex-amination of the pancreatic transection margin was investigated. Results All the 69 patients were con-firmed pathologically. Of the 69 patients, 13 suffered from serous cystic neoplasms, 30 from mucinous cystic neoplasms,7 from intraductal papillary mucinous neoplasms,12 from solid pseudopapillary neo-plasms and 7 from cystic neoplasms. Forty-four lesions were diagnosed as malignant or borderline.Univariate analysis should that jaundice, raised CEA and/or CA19-9, maximum diameters and solid component of cystic neoplasmshad were of statistical significance for the risk of malignancy in CNP.The sensitivity was 34.1% (15/44), 47.7 % (21/44), 88.6%(39/44),72.7%(32/44) and specificity 96% (24/25), 84% (23/25), 68% (17/25),72% (18/25), respectively. The last three were identified as independent predictive factors for malignancy by multivariate analysis. Three cases were accurately diagnosed out of the 9 undergoing FNA preoperatively. One of 7 patients with intraductal papillary mucinous neoplasms (IPMN) undenwent total pancreatetomy for transection margin positivity.Conclusion Most malignant CNP can be accurately diagnosed preoperatively from a typical clinical,biochemical and cross-sectional imaging picture. FNA is only used in the patients who are potential candidates for nonoperative management. Margin analysis is necessary for pancreatic resection.
