介入或手术治疗胰腺囊性病变82例临床回顾

摘要

目的：探究胰腺囊性病变的临床表现、实验室检查、影像学等特点，为胰腺囊性病变的诊治提供依据。方法：回顾性分析2004年至2014年南京医科大学上海一院经介入或手术治疗并最终经病理确诊的胰腺囊性病变患者的临床特点并结合文献进行总结。结果：纳入82例胰腺囊性病变患者，其中假性囊肿26例，先天性囊肿2例，潴留囊肿4例，浆液性囊性肿瘤14例，黏液性囊性肿瘤16例，导管内乳头状瘤12例，实性假乳头状瘤7例，神经内分泌肿瘤囊性变1例。超声、CT、MRI、正电子发射计算机断层显像（ PET－CT）、经内镜逆行性胰胆管造影术（ ERCP）及超声内镜（ EUS）对囊性病变诊断准确率分别为16．6％、30．4％、37．8％、20％、40％及77．8％。16例胰腺假性囊肿行超声内镜引导下经胃壁内引流术，余66例患者行外科手术治疗。结论：胰腺囊性病变多无特征性临床表现，CT、MRI和EUS为囊性病变诊断的重要方法，对除假性囊肿外的其他病理类型，应积极采取手术治疗。%Objective: To summarize the clinic characteristics of pancreatic cystic lesions and provide basis for diagnosis and treatment of the disease.Methods: The clinical data of patients with pancreatic cystic lesions from 2004 to 2014 in Shanghai General Hospital of Nanjing Medical University was retrospectively analyzed.Results:Eighty-two patients with pancreatic cystic lesions were enrolled in the investigation, of whom 26 patients were pancreatic pseudocyst,4 retention cyst,2 congenital cyst,14 serous cystic neoplasm(SCN),16 mucinous cystic neoplasm( MCN) ,12 intraductal papillary mucinous neoplasm( IPMN) ,7 solidpseudopapillary neoplasm( SPN) and 1 was pancreatic neuroendocrine cystic tumor.The diagnostic accuracy rates of B ultrasound, CT, MRI/MRCP, PET-CT,ERCP and EUS were 16.6%,30.4%,37.8%,20%,40% and 77.8% respectively.Sixteen cases of pancreatic pseudocysts were treated by EUS-guided transgastric drainage and the others received laparotomy. Conclusion:Pancreatic cystic lesion has no special and typical clinical manifestations.CT,MRI/MRCP and EUS play an important role in the diagnosis of pancreatic cystic lesions.All cystic lesions except pancreatic pseudocyst should be treated by surgery.