胰腺神经鞘瘤临床诊治分析

摘要

目的：探讨胰腺神经鞘瘤的临床特点和诊治方法。方法总结并回顾性分析我院肝胆外科收治的胰腺神经鞘瘤患者1例及文献报道的71例患者临床资料。结果共计72例胰腺神经鞘瘤患者纳入总结和分析。患者平均年龄54岁（范围17～89岁），其中女性40例（56％）。临床表现包括上腹痛、体重减轻，或体检偶然发现胰腺肿物。肿瘤平均大小6．1 cm （1～20 cm）。肿瘤位于胰头部29例（40％）、胰体／尾部32例（44％），沟突部6例（8％）。肿瘤表现为实性肿物27例（38％）、囊性28例（39％）、囊实性10例（14％）。2例通过术前超声内镜下穿刺活检病理确诊，其余均为手术后标本病理诊断证实。手术治疗行胰十二指肠切除术23例、局部剜除术16例、胰体尾切除术15例、胰腺中段切除1例。5例（7％）患者术后病理为恶性神经鞘瘤，恶性组肿瘤大小明显大于良性组[（13．8±6．2）cm vs （5．6±4．1）cm，P ＝0．0004）]。手术切除患者术后随访3～65月，均无肿瘤复发、转移及患者死亡。结论胰腺神经鞘瘤临床表现缺少特异性，术前诊断困难，肿瘤大小与良恶性具有明显相关性，手术治疗可取得良好效果。%Objective To analyze clinical presentation,diagnosis,treatment options,and outcome of pancreatic schwannoma. Methods A retrospective study of clinical data of a case in our hospital and 71 cases reported in literature with pancreatic schwannoma. Results 72 cases were analysed.The mean age was 54 years (range 1 7-89 years),with 56 % of pa-tients being female.Mean tumor size was 6.1 cm (range 1 -20 cm).Tumor location was the head (29 cases),body and tail (32 cases),and uncinate process (6 cases).27 cases exhibited solid tumors and 28 cases exhibited cystic tumors.Treatment includ-ed pancreaticoduodenectomy (23 cases),distal pancreatectomy (1 5 cases),enucleation (1 6 cases).5 cases (7%)were ma-lignant schwannoma.Tumor size of malignant group was significant larger than benign group (1 3.8 ±6.2 cm vs 5.6 ±4.1 cm, P =0.0004).There was no local recurrence metastasis,or death at the follow-up after operation (range 3-65 months). Con-clusion The clinical manifestations of pancreatic schwannoma are lack of specificity and preoperative diagnosis remains difficul-ty.The tumor size was significantly related to classification of malignant or benign.Pancreatic schwannoma has satisfactory prog-nosis with surgical treatment.