摘要:
Objective To analyze the current status of diagnosis and treatment of pancreatic cystic neoplasm(PCN)in China.Methods Clinical data of 2 251 PCN patients who underwent surgical resection from January 2006 to December 2016 in 16 institutions was retrospectively analyzed.Excel database was created which covered 132 fields of 7 fields:general information of patients,imaging findings,preoperative blood biochemical indexes,tumor markers,surgical related data,postoperative complications and pathology.Results Of the 2 251 patients,the male to female ratio was 1.0 to 2.4,and the mean age at diagnosis was 47.5 years (range,8-89 years).Solid pseudo-papillary tumor (SPT),Serouscystic neoplasm (SCN),Intraductal papillary mucinous neoplasm (IPMN),mucinous cystic neoplasm (MCN) were 713 cases,678 cases,495 cases,365 cases,respectively;and the malignant transformation rate was 12.3%,0.6%,32.1%,10.4%,respectively.Carcinoembryonic antigen,CA19-9,CA125 were significantly increased in the malignant group.The incidence of postoperative complications in SCN was the highest.Preoperative CT scan was the most common method in China.The characteristics of IPMN included atrophy of pancreas body and tail,dilatation of the main pancreatic duct,and pancreatitis,and these characteristics were three to six times more than other 3 kinds of PCN.The correct rate of preoperative diagnosis to subtype was 33.0%.Conclusions SPT is the most common tumor in all PCN in China.One of the key research directions is to improve the accuracy of subtype diagnosis to avoid unnecessary surgery.%目的 了解中国胰腺囊性肿瘤(PCN)诊治现状.方法 回顾性分析中国16家胰腺中心2006年1月1日至2016年12月31日收治的经病理学检查结果证实的PCN手术病例资料.建立Excel数据库,涵盖患者一般信息、影像学表现、术前血生化指标、肿瘤标志物、手术相关数据、术后并发症、病理学检查结果7个领域132个字段.结果 在手术切除的2 251例PCN病例中,男女比例为1.0:2.4,获得诊断时平均年龄为47.5岁(8~ 89岁).实性假乳头状肿瘤(SPT)最常见,占31.7%(n=713),其次是浆液性囊腺瘤(SCN)和导管内乳头状黏液性肿瘤(IPMN),分别占30.1%(n=678)和22.0%(n=495),黏液性囊腺瘤(MCN)所占比例最少,为16.2%(n=365).PCN恶变组患者肿瘤标志物癌胚抗原、CA19-9、CA125的表达水平显著高于无恶变组.PCN恶变率相差较大,最高为IPMN(32.1%),最低为SCN,仅0.6%.但SCN手术风险最大,术后总体并发症发生率高达50.3%,为四种PCN之首.术前CT检查在我国是最常见的检查方法.胰体尾萎缩、主胰管扩张、胰腺炎是IPMN的特征性表现,发生率是其他3种PCN的3~6倍.PCN术前模糊诊断常见、错误诊断率高,术前精确到亚型的正确诊断率仅为33.0%,尤以SCN最低(13.7%).结论 提高我国PCN影像学诊断能力,术前精确判断PCN亚型,有助于推动PCN的规范治疗.尤其是术前精准识别SCN,可避免不必要的手术治疗.