CAJ | 학술논문

目的总结胰腺囊性肿瘤外科诊治经验.方法回顾性分析2003年1月至2012年12月本院收治的126例胰腺囊性肿瘤患者的临床和病理资料.结果患者无特异性临床表现,腹部超声、CT和MRI诊断的正确率分别为90.8％(109/120)、93.4％(114/122)和96.3％(103/107).126例均查血清肿瘤标记物,CA19 9升高18例(14.3％),CEA升高10例(7.9％).开放手术105例,腹腔镜手术21例.肿瘤局部摘除术11例(含腹腔镜手术5例),胰腺节段切除术5例,保留脾脏的胰体尾切除术30例(含腹腔镜手术10例),胰体尾及脾切除术26例(含腹腔镜手术6例,联合肝部分切除术1例,联合胃、结肠切除术1例),保留十二指肠的胰头切除术4例,保留幽门的胰头十二指肠切除术5例,胰头十二指肠切除术38例(含4例联合门静脉和/或肠系膜上静脉切除人工血管重建术),全胰切除术2例,剖腹探查术及肿瘤活检术5例.126例中,围手术期死亡1例,术后胰瘘(B、C级)发生率为12.7％,术后出血(B、C级)发生率为7.1％.114例患者获得随访.随访6～72个月不等,中位随访时间52.4个月.总体5年生存率为80.5％.其中非浸润性肿瘤术后5年生存率为96.4％,浸润性肿瘤术后5年生存率为40.7％.结论大多数胰腺囊性肿瘤为良性,部分为恶性或有恶变及转移潜能.无临床症状且较小的良性肿瘤可严密随访.有临床症状或有恶性征象者应积极手术治疗.非浸润性肿瘤宜选择功能保留性手术,浸润性肿瘤应做规则性胰腺切除并区域淋巴结清扫,必要时行联合脏器切除.
목적 총결이선낭성종류외과진치경험.방법 회고성분석2003년1월지2012년12월본원수치적126례이선낭성종류환자적림상화병리자료.결과 환자무특이성림상표현,복부초성、CT화MRI진단적정학솔분별위90.8％(109/120)、93.4％(114/122)화96.3％(103/107).126례균사혈청종류표기물,CA19 9승고18례(14.3％),CEA승고10례(7.9％).개방수술105례,복강경수술21례.종류국부적제술11례(함복강경수술5례),이선절단절제술5례,보류비장적이체미절제술30례(함복강경수술10례),이체미급비절제술26례(함복강경수술6례,연합간부분절제술1례,연합위、결장절제술1례),보류십이지장적이두절제술4례,보류유문적이두십이지장절제술5례,이두십이지장절제술38례(함4례연합문정맥화/혹장계막상정맥절제인공혈관중건술),전이절제술2례,부복탐사술급종류활검술5례.126례중,위수술기사망1례,술후이루(B、C급)발생솔위12.7％,술후출혈(B、C급)발생솔위7.1％.114례환자획득수방.수방6～72개월불등,중위수방시간52.4개월.총체5년생존솔위80.5％.기중비침윤성종류술후5년생존솔위96.4％,침윤성종류술후5년생존솔위40.7％.결론 대다수이선낭성종류위량성,부분위악성혹유악변급전이잠능.무림상증상차교소적량성종류가엄밀수방.유림상증상혹유악성정상자응적겁수술치료.비침윤성종류의선택공능보류성수술,침윤성종류응주규칙성이선절제병구역림파결청소,필요시행연합장기절제.
Objective To summerize our experience in the diagnosis and treatment of pancreatic cystic neoplasms.Methods A retrospective analysis was conducted on the clinical data of 126 patients with pancreatic cystic neoplasms seen between January 2003 and December 2012 in the Fuzhou General Hospital.Results There was no special clinical manifestation in this series of 126 patients with pancreatic cystic neoplasms.The diagnostic accuracies of ultrasound,CT and MRI were 90.8％ (109/120),93.4％ (114/122) and 96.3％ (103/107) respectively.Eighteen and ten patients were observed to have elevated serum CA19 9 and CEA respectively.One hundred and five patients received conventional open surgery,while 21 patients underwent laparoscopic operations.The operations in cluded enucleation of tumor (n=11),pancreatic segment resection (n=5),spleen preserving distal pancreatectomy (n=30),distal pancreatectomy (n=26),duodenum-preserving pancreatic head resection (n=4),pylorus-preserving Whipple resection (n=5),Whipple procedure (n=38),total pancre atectomy (n=2) and exploratory laparotomy and biopsy (n=5).The perioperative mortality rate was 0.8％ (1/126).Pancreatic fistula (B and C) occurred in 16 patients (12.7％,16/126),and postoperative hemorrhage (B and C) occurred in 9 patients (7.1％,9/126).One hundred and fourteen patients were followed up from 6 to 72 months (median 52.4 months).The five-year survival rates for all the pancreatic cystic neoplasms,non-invasive and invasive neoplasms were 80.5％,96.4％ and 40.7％ respectively.Conclusions Pancreatic cystic neoplasms are a rare subset of pancreatic tumor,being increasingly detected due to the widespread use of abdominal imaging and improved imaging techniques.Most of them are benign,but some are malignant or they have malignant transformation and metastatic potential.Patients with asymptomatic benign pancreatic cystic neoplasms,especially small size,are candidates for observation.Patients with clinical symptoms or having a high suspicion of malignancy should be offered surgical resection.Non-invasive neoplasms should receive pancreatic preserving operations.Pancreatectomy plus regional lymph nodes dissection with or without combined resection of adjacent multi organs should be adopted for invasive neoplasms.