CAJ | 학술논문

目的：探讨保留脾脏的胰体尾肿瘤切除术治疗小儿胰腺实性假乳头状瘤的可行性及临床疗效评估。方法回顾性分析2009年1月-2012年12月在天津市儿童医院收治的位于胰体尾部胰腺实性假乳头状瘤患儿4例，均成功行保留脾脏的胰体尾肿瘤切除术。术后均在门诊随访，内容包括腹部B超和 CT检查，肿瘤标记物和胰腺外分泌功能，并由专人测量其生长发育情况。结果患儿手术过程顺利，切除肿瘤及部分胰体尾，全部成功保留脾脏，肿瘤直径介于4.0～12.5 cm，包膜完整，手术过程中无脾脏动、静脉损伤及脾实质撕裂伤，无术中输血。术后3d肠功能恢复后开始进食，恢复过程顺利，住院时间为6～9d。无围手术期出血、胰瘘等并发症发生。病理检查结果均为胰腺实性假乳头状瘤，Ki-67＜5％。所有患儿获得随访，时间为6～48个月，均健康存活，生长发育正常。腹部B 超、CT检查未见肿瘤复发，肿瘤标记物及胰腺外分泌功能检查未见异常。结论发生在胰体尾部的胰腺实性假乳头状瘤虽然肿瘤直径较大，但是包膜完整，与胰腺血管关系疏松，易于将脾脏动静脉分开而成功保留脾脏。
목적：탐토보류비장적이체미종류절제술치료소인이선실성가유두상류적가행성급림상료효평고。방법회고성분석2009년1월-2012년12월재천진시인동의원수치적위우이체미부이선실성가유두상류환인4례，균성공행보류비장적이체미종류절제술。술후균재문진수방，내용포괄복부B초화 CT검사，종류표기물화이선외분비공능，병유전인측량기생장발육정황。결과환인수술과정순리，절제종류급부분이체미，전부성공보류비장，종류직경개우4.0～12.5 cm，포막완정，수술과정중무비장동、정맥손상급비실질시렬상，무술중수혈。술후3d장공능회복후개시진식，회복과정순리，주원시간위6～9d。무위수술기출혈、이루등병발증발생。병리검사결과균위이선실성가유두상류，Ki-67＜5％。소유환인획득수방，시간위6～48개월，균건강존활，생장발육정상。복부B 초、CT검사미견종류복발，종류표기물급이선외분비공능검사미견이상。결론발생재이체미부적이선실성가유두상류수연종류직경교대，단시포막완정，여이선혈관관계소송，역우장비장동정맥분개이성공보류비장。
Objective To evaluate the feasibility and clinical effect of which is on the basis of spleen-preserving distal pancreatectomy with solid pseudopapillary neoplasm of the pancreas in Children. Methods A retrospective study was made on 4 SPN patients treated in Tianjin Children′s Hospital from January 2009 to December 2012.This group of cases was treated by on the basis of spleen- preserving resection of pancreatic body and tail tumors,then follow-up in outpatient service.Results All Patients in this group have removed the distal pancreatic with SPN and spleen-preserving successfully.All tumors are between 4.0-12.5 cm in diameter and their envelopes were integrity.Meanwhile,splenic artery, veins and parenchyma of spleen were not injured during the process of operation.The cases of group feed three days after surgery,restored smoothly and lived in hospital for 6-9 days.After operation,they were not found complication including postoperative hemorrhage,pancreatic fistula and so on.Pathological examination confirmed for solid pseudopapillary neoplasm of the Pancreas.All patients had a follow-up in the clinic for 12-94 months and all survived.Furthermore,special nurse examined the growth and development of the patients after surgery in the clinic;they are in the normal extent compare to the standard.And found no tumor recurrence using the B-us and CT scan examination.Conclusion While the diameter of Solid pseudopapillary neoplasm of the Pancreas of pancreatic body and tail is large,its envelope is complete,so easy to separate from the spleen arterial venous and successful preserve spleen.