目的 探讨胰腺囊性肿瘤的临床特点以及诊断与治疗.方法 回顾性分析2010年1月至2014年12月安徽医科大学第一附属医院收治的62例胰腺囊性肿瘤患者的临床资料.良性黏液性囊腺瘤(MCN)、浆液性囊腺瘤(SCN)、良性实性假乳头状瘤(SPN)、导管内乳头状黏液瘤(IPMN)设为良性肿瘤患者,交界性或恶性MCN、交界性或恶性IPMN设为恶性肿瘤患者.分析患者性别、年龄、临床症状、影像学检查结果、实验室检查结果、手术方式、手术时间、术中出血量、围术期并发症、病理学检查结果和随访结果等指标.采用电话及门诊复查相结合的方式随访,随访时间截至2014年12月31日或患者死亡.正态分布的计量资料以x±s表示,非正态分布的计量资料以M(范围)表示,计数资料采用x2检验或Fisher确切概率法进行单因素分析,采用Logistic回归模型进行多因素分析.结果 62例患者中,31例因上消化道不适症状等就诊,10例无特异性表现,在健康体检时发现,10例近2～3个月出现体质量明显减轻,9例可触及腹部包块,2例因梗阻性黄疸入院.62例患者影像学检查发现肿瘤直径为(60 ±35) mm;肿瘤位于头颈部11例,胰体尾部51例.其中33例患者发现囊内结节或实性成分,6例发现主胰管扩张.患者B超、CT、MRI、超声内镜(EUS)及PET/CT检查的诊断阳性率分别为85.5％ (53/62)、93.2％(55/59)、94.1％(16/17)、100.0％ (3/3)及100.0％(2/2).62例患者术前CEA为1.22 μg/L(0.20 ～ 12.98 μg/L),CA19-9为10.85 U/mL(0.60 ～1 000.00 U/mL);CEA升高者仅占4.8％ (3/62),CA19-9升高者仅占14.5％ (9/62).62例患者均行手术治疗,其中联合脾脏切除的胰体尾切除术36例,胰十二指肠切除术10例,胰腺部分切除术7例,保留脾脏的胰体尾切除术6例,单纯囊肿切除术2例,姑息性胆肠Roux-en-Y吻合术1例.手术切除率为98.4％ (61/62),手术时间为(219 ±79) min,术中出血量为(299±296) mL.术后13例患者出现不同程度的并发症,经过禁食、止血、抗感染等对症支持处理均好转.病理学检查结果:MCN 27例(恶性或交界性MCN 11例),SCN 18例,SPN 11例,IPMN 6例(恶性或交界性IPMN 3例).62例患者获得随访,随访时间为3 ～ 63个月,2例恶性肿瘤患者死亡,其余患者预后良好.单因素分析结果:发病年龄、肿瘤直径、术前CEA、术前CA19-9是影响患者肿瘤恶性程度的相关因素(x2=18.798,12.335,7.281,10.073,P＜0.05).多因素分析结果:年龄≥65岁、术前CA19-9≥34.00 U/mL是影响患者肿瘤恶性程度的独立危险因素(RR =0.923,0.994;95％可信区间:0.863 ～0.987,0.988～0.999,P＜0.05).结论 胰腺囊性肿瘤无特异性临床表现;B超、CT和MRI检查是胰腺囊性肿瘤的主要检查方法;胰腺囊性肿瘤患者术后总体预后较好;年龄≥65岁和术前CA19-9≥34.00 U/mL是胰腺囊性肿瘤恶性程度的独立危险因素.
目的 探討胰腺囊性腫瘤的臨床特點以及診斷與治療.方法 迴顧性分析2010年1月至2014年12月安徽醫科大學第一附屬醫院收治的62例胰腺囊性腫瘤患者的臨床資料.良性黏液性囊腺瘤(MCN)、漿液性囊腺瘤(SCN)、良性實性假乳頭狀瘤(SPN)、導管內乳頭狀黏液瘤(IPMN)設為良性腫瘤患者,交界性或噁性MCN、交界性或噁性IPMN設為噁性腫瘤患者.分析患者性彆、年齡、臨床癥狀、影像學檢查結果、實驗室檢查結果、手術方式、手術時間、術中齣血量、圍術期併髮癥、病理學檢查結果和隨訪結果等指標.採用電話及門診複查相結閤的方式隨訪,隨訪時間截至2014年12月31日或患者死亡.正態分佈的計量資料以x±s錶示,非正態分佈的計量資料以M(範圍)錶示,計數資料採用x2檢驗或Fisher確切概率法進行單因素分析,採用Logistic迴歸模型進行多因素分析.結果 62例患者中,31例因上消化道不適癥狀等就診,10例無特異性錶現,在健康體檢時髮現,10例近2～3箇月齣現體質量明顯減輕,9例可觸及腹部包塊,2例因梗阻性黃疸入院.62例患者影像學檢查髮現腫瘤直徑為(60 ±35) mm;腫瘤位于頭頸部11例,胰體尾部51例.其中33例患者髮現囊內結節或實性成分,6例髮現主胰管擴張.患者B超、CT、MRI、超聲內鏡(EUS)及PET/CT檢查的診斷暘性率分彆為85.5％ (53/62)、93.2％(55/59)、94.1％(16/17)、100.0％ (3/3)及100.0％(2/2).62例患者術前CEA為1.22 μg/L(0.20 ～ 12.98 μg/L),CA19-9為10.85 U/mL(0.60 ～1 000.00 U/mL);CEA升高者僅佔4.8％ (3/62),CA19-9升高者僅佔14.5％ (9/62).62例患者均行手術治療,其中聯閤脾髒切除的胰體尾切除術36例,胰十二指腸切除術10例,胰腺部分切除術7例,保留脾髒的胰體尾切除術6例,單純囊腫切除術2例,姑息性膽腸Roux-en-Y吻閤術1例.手術切除率為98.4％ (61/62),手術時間為(219 ±79) min,術中齣血量為(299±296) mL.術後13例患者齣現不同程度的併髮癥,經過禁食、止血、抗感染等對癥支持處理均好轉.病理學檢查結果:MCN 27例(噁性或交界性MCN 11例),SCN 18例,SPN 11例,IPMN 6例(噁性或交界性IPMN 3例).62例患者穫得隨訪,隨訪時間為3 ～ 63箇月,2例噁性腫瘤患者死亡,其餘患者預後良好.單因素分析結果:髮病年齡、腫瘤直徑、術前CEA、術前CA19-9是影響患者腫瘤噁性程度的相關因素(x2=18.798,12.335,7.281,10.073,P＜0.05).多因素分析結果:年齡≥65歲、術前CA19-9≥34.00 U/mL是影響患者腫瘤噁性程度的獨立危險因素(RR =0.923,0.994;95％可信區間:0.863 ～0.987,0.988～0.999,P＜0.05).結論 胰腺囊性腫瘤無特異性臨床錶現;B超、CT和MRI檢查是胰腺囊性腫瘤的主要檢查方法;胰腺囊性腫瘤患者術後總體預後較好;年齡≥65歲和術前CA19-9≥34.00 U/mL是胰腺囊性腫瘤噁性程度的獨立危險因素.
목적 탐토이선낭성종류적림상특점이급진단여치료.방법 회고성분석2010년1월지2014년12월안휘의과대학제일부속의원수치적62례이선낭성종류환자적림상자료.량성점액성낭선류(MCN)、장액성낭선류(SCN)、량성실성가유두상류(SPN)、도관내유두상점액류(IPMN)설위량성종류환자,교계성혹악성MCN、교계성혹악성IPMN설위악성종류환자.분석환자성별、년령、림상증상、영상학검사결과、실험실검사결과、수술방식、수술시간、술중출혈량、위술기병발증、병이학검사결과화수방결과등지표.채용전화급문진복사상결합적방식수방,수방시간절지2014년12월31일혹환자사망.정태분포적계량자료이x±s표시,비정태분포적계량자료이M(범위)표시,계수자료채용x2검험혹Fisher학절개솔법진행단인소분석,채용Logistic회귀모형진행다인소분석.결과 62례환자중,31례인상소화도불괄증상등취진,10례무특이성표현,재건강체검시발현,10례근2～3개월출현체질량명현감경,9례가촉급복부포괴,2례인경조성황달입원.62례환자영상학검사발현종류직경위(60 ±35) mm;종류위우두경부11례,이체미부51례.기중33례환자발현낭내결절혹실성성분,6례발현주이관확장.환자B초、CT、MRI、초성내경(EUS)급PET/CT검사적진단양성솔분별위85.5％ (53/62)、93.2％(55/59)、94.1％(16/17)、100.0％ (3/3)급100.0％(2/2).62례환자술전CEA위1.22 μg/L(0.20 ～ 12.98 μg/L),CA19-9위10.85 U/mL(0.60 ～1 000.00 U/mL);CEA승고자부점4.8％ (3/62),CA19-9승고자부점14.5％ (9/62).62례환자균행수술치료,기중연합비장절제적이체미절제술36례,이십이지장절제술10례,이선부분절제술7례,보류비장적이체미절제술6례,단순낭종절제술2례,고식성담장Roux-en-Y문합술1례.수술절제솔위98.4％ (61/62),수술시간위(219 ±79) min,술중출혈량위(299±296) mL.술후13례환자출현불동정도적병발증,경과금식、지혈、항감염등대증지지처리균호전.병이학검사결과:MCN 27례(악성혹교계성MCN 11례),SCN 18례,SPN 11례,IPMN 6례(악성혹교계성IPMN 3례).62례환자획득수방,수방시간위3 ～ 63개월,2례악성종류환자사망,기여환자예후량호.단인소분석결과:발병년령、종류직경、술전CEA、술전CA19-9시영향환자종류악성정도적상관인소(x2=18.798,12.335,7.281,10.073,P＜0.05).다인소분석결과:년령≥65세、술전CA19-9≥34.00 U/mL시영향환자종류악성정도적독립위험인소(RR =0.923,0.994;95％가신구간:0.863 ～0.987,0.988～0.999,P＜0.05).결론 이선낭성종류무특이성림상표현;B초、CT화MRI검사시이선낭성종류적주요검사방법;이선낭성종류환자술후총체예후교호;년령≥65세화술전CA19-9≥34.00 U/mL시이선낭성종류악성정도적독립위험인소.
Objective To investigate the clinical features,diagnosis and treatment of pancreatic cystic neoplasms.Methods The clinical data of 62 patients with pancreatic cystic neoplasms who were admitted to the First Affiliated Hospital of Anhui Medical University from January 2010 to December 2014 were retrospectively analyzed.Benign neoplasms included benign mucinous cystic neoplasm (MCN),serous cystic neoplasm (SCN),solid pesudopapillary neoplasm (SPN) and intraductal papillary mucinous neoplasm (IPMN) and malignant neoplasms included borderline or malignant MCN and borderline or malignant IPMN.The sex,age,clinical symptoms,imaging features,laboratory results,surgical method,operation time,volume of intraoperative blood loss,perioperative complications,result of pathological examination and follow-up were analyzed.Patients were followed up by telephone interview and outpatient examination up to 31,December 2014 or death.Measurement data with normal distribution were presented by (x) ± s,while measurement data with non-normal distribution were presented by M (range).Univariate analysis of count data was done by chi-square test or Fisher exact probability.Multivariate analysis was done by Logistic regression model.Results Of the 62 patients with pancreatic cystic neoplasms,31 were retreated due to upper digestive discomfort,10 without specific features were found during the health examinations,10 due to weight loss in near 2-3 months,9 due to abdominal masses and 2 due to obstructive jaundice.Results of radiographic examinations showed that the diameter of the tumor is (60 ± 35) mm,11 of tumors located in the head and neck of pancreas and 51 located in the body and tail of pancreas.The cystic nodule or solid ingredients were detected in 33 patients and main pancreatic duct dilation in 6 patients.The positive diagnostic rates of B ultrasound,computed tomography (CT),magnetic resonance imaging (MRI),and endoscopic ultrasonography (EUS) and positron emission tomography-computed tomography (PET/CT) were 85.5％ (53/62),93.2％ (55/59),94.1％ (16/17),100.0％ (3/3) and 100.0％ (2/2).Preoperative serum CEA and serum CA19-9 were 1.22 μg/L(0.20-12.98 μg/L) and 10.85 U/mL (0.60-1 000.00 U/mL),while the percentage of patients with increasing CEA and CA19-9 were 4.8％ (3/62) and 14.5％ (9/62),respectively.All the 62 patients received surgery,distal pancreatectomy (DP) combined with splenectomy were performed on 36 patients,pancreatoduodenectomy on 10 patients,partial pancreatic resection on 7 patients,spleen-preserving DP on 6 patients,cyst-resection on 2 patients and palliative Roux-en-Y anastomosis on 1 patient.The rate of surgical resection,operation time and volume of blood loss were 98.4％ (61/62),(219 ± 79) minutes and (299 ± 296) mL.After operation,13 patients had different degrees of complication,and were improved by symptomatic treatment such as jejunitas,hemostasis and anti-infection.The results of pathological examination showed that 27 patients were with MCN (11 with malignant or borderline MCN),18 with SCN,11 with SPN and 6 with IPMN (3 with malignant or borderline IPMN).All the patients were followed up for 3-63 months with good prognoses,except for the death of 2 patients.The results of univariate analysis showed that age of onset,tumor diameter,preoperative serum CEA and preoperative serum CA19-9 were related factors affecting diagnosis of malignant tumor (x2=18.798,12.335,7.281,10.073,P ＜0.05).The results of multivariate analysis showed that age≥65 years and preoperative serum CA19-9 ≥34.00 U/mL were independent risk factors affecting diagnosis of malignant tumor (RR =0.923,0.994;95 ％ confidence interval:0.863-0.987,0.988-0.999;P ＜ 0.05).Conclusions B ultrasound,CT and MRI are the main diagnostic methods for pancreatic cystic neoplasms without specific clinical features.Patients with pancreatic cystic neoplasms have overall good prognosis.The results of multivariate analysis showed that age ≥ 65 years and preoperative serum CA19-9 ≥34.00 U/mL are independent risk factors affecting tumor malignancy.
