胰腺黏液性囊性肿瘤113例治疗分析

摘要

目的 探讨胰腺黏液性囊性肿瘤的临床病理学特征及影响预后的相关因素.方法 回顾性分析1994年1月至2015年6月解放军总医院肝胆外科收治的经术后病理检查证实为胰腺黏液囊性肿瘤的113例患者的临床资料,男性21例,女性92例,年龄21 ～ 81岁,平均年龄(50.2±14.5)岁.无明显症状仅因体检或其他原因意外发现48例(42.5％),症状明显65例(57.5％),腹痛、腹胀等腹部不适为主要临床表现.根据术后病理检查结果,参考2010 WHO胰腺肿瘤分类标准:伴有不典型增生或癌前病变75例,伴有浸润性癌38例.分别采用秩和检验、x2检验等方法对数据进行统计学分析.结果 肿瘤好发于胰体尾部.性别、平均年龄、有无症状、肿瘤最大径、CA19-9在伴有不典型增生和浸润性癌的黏液性肿瘤患者中的差异有统计学意义(P值均＜0.05).恶性肿瘤更易出现囊内乳头状结构(x2 =32.460,P=0.000)及合并主胰管扩张(x2=5.729,P=0.022).58例伴有不典型增生的患者获得随访,仅1例患者术后复发.31例伴浸润性癌患者获得随访,死亡22例,其1、3、5年生存率分别为76.9％、56.5％、36.6％.淋巴结转移和术后肿瘤复发是影响恶性肿瘤患者预后的重要危险因素(P值均＜0.05).结论 胰腺黏液性囊性肿瘤好发于老年女性患者,无特异性临床表现,常见于胰体尾部.手术切除后,伴有不典型增生的患者预后较好,伴有浸润性癌患者预后较差.%Objective To describe the clinicopathological characteristics and prognostic factors of mucinous cystic neoplasm(MCN).Methods One hundred and thirteen patients with MCN comfirmed by histological examination admitted in People's Liberation Army General Hospital from January 1994 to June 2015 were analyzed,including 21 male and 92 female patients with mean age of (50.2 ± 14.5) years.Fortyeight patients had incidental discovery of their cystic neoplasm for another reason,65 patients were symptomatic,and abdominal pain or distension was main clinical symptom.Among 113 patients with MCN,75 cases were MCN with dysplasia,and 38 cases were MCN with invasive carcinoma.Wilcoxon test and x2 test,et al were used to analyzed the data,respectively.Results MCN was mostly located in body and tail of pancreas.Sex,mean age,clinical symptom,tumor size,and CA19-9 showed significant difference between MCN with dysplasia and MCN with invasive carcinoma (all P ＜ 0.05).The presence of a solid component (x2 =32.460,P =0.000) and main pancreatic duct dilation (x2 =5.729,P =0.022) were significantly associated with malignancy.Fifty-eight patients with dysplasia were followed up,only one patient occurred tumor recurrence.Thirty-one patients with malignancy were followed up,among which there were 22 patients dead,1-,3-,5-year survival of MCN with malignancy was 76.9％,56.5％,36.6％,respectively.Lymphatic metastasis and tumor recurrence were important prognostic factors of MCN with malignancy(both P ＜ 0.05).Conclusions MCN is most affected by old female with no specific symptom,most tumors are located at the body and tail of the pancreas.MCN with dysplasia have excellent prognosis underwent surgery.Even with complete resection,the long-term survival of MCN with malignancy is not satisfied.