胰腺粘液性囊性肿瘤32例诊疗体会

摘要

目的 总结胰腺粘液性囊性肿瘤(MCN)的临床特点,探讨MCN的诊断与治疗.方法 对2005年1月到2015年1月大连医科大学附属第一医院收治的32例MCN患者的临床资料进行回顾性分析,其中男性9例,女性23例;年龄24 ～ 78岁,平均53岁.术前16例患者行B超检查,全部患者均行CT检查且发现病灶.32例患者均行手术治疗.结果 32例MCN患者均经术后病理确诊.包括胰腺粘液性囊腺瘤25例,胰腺粘液性囊腺癌7例;囊肿直径4 ～ 22 cm,平均5.4 cm;位于胰头颈部14例,胰体尾19例,其中1例患者胰腺有两处病灶,分别位于胰头部及胰尾部,术后病理证实均为胰腺粘液性囊腺瘤.3例病人术后发生胰漏和腹腔感染,经保守治疗后均治愈.结合术后病理切缘情况,31例患者得到根治性切除,1例患者切缘为阳性.无围手术期死亡病例,术后患者均获得随访,2例囊腺癌因复发转移分别于术后11个月和32个月死亡,2例患者死于其他疾病,其余均存活,无复发.结论 胰腺粘液性囊性肿瘤患者无特征性临床表现.女性患者多于男性患者.B超和CT是胰腺粘液性囊性肿瘤的主要诊断方法.胰腺粘液性囊性肿瘤往往有恶变倾向,临床常不能鉴别其肿瘤的性质,因此有必要行手术治疗.胰腺粘液性囊腺瘤手术切除后可获得良好的治疗效果,囊腺癌术后疗效也较满意.%Objective To summarize the clinical features of mucinous cystic neoplasms (MCN) of the pancreas and to discuss the diagnosis and treatment of MCN of the pancreas.Methods The clinical data of 32 patients with MCN of the pancreas in the First Affiliated Hospital of Dalian Medical University from January 2005 to January 2015 were retrospectively analyzed.Among them,9 patients were male and 23 were female.Ages ranged from 24 to 78 years old and the average age was 53 years old.All of the 16 patients underwent CT examination before operation.Surgical treatment was performed in 32 patients and all patients were diagnosed as mucinous cystic neoplasms of the pancreas in postoperative pathology.Results The 32 cases of mucinous cystic neoplasms of the pancreas included 25 cases of pancreatic mucinous cystadenoma and 7 cases of mucinous adenocarcinoma.The diameter of the cysts ranged 4 ～ 22 cm and the average was 5.4 cm.There were 14 cases in the neck of caput pancreas,and 19 cases in the tail of corpora pancreas.Among them 1 has two cases of pancreatic lesions,located in the pancreatic head and tail of pancreas,postoperative pathology confirmed for pancreatic mucinous cystic adenoma.The final diagnosis of the lesions depended on the postoperative pathological examination.Three cases of postoperative pancreatic leakage and abdominal infection were cured after conservative treatment.Based on the postoperative pathological margins,31 patients had radical resection,and 1 patient had a positive margin.There were no perioperative death.All patients were followed up.Two patients with cystadenocarcinoma died in 11 months and 32 months after operation due to recurrence and metastasis,and 2 patients died of other diseases.The others patients were alive without recurrence.Conclusion Patients with MCN of the pancreas have no specific clinical features.They occur more in women than men.Type-B ultrasound and CT are the main diagnostic methods.MCN of the pancreas have malignant potential and are often difficult to differentiate from other tumors clinically,thus often require surgical treatment.Surgical resection of pancreatic mucinous cystadenoma can obtain good therapeutic effects.The curative effects of postoperative cystadenocarcinoma are also satisfactory.