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目的探讨胰腺囊性肿瘤的诊治策略。方法回顾性总结2002-2012年间复旦大学附属华山医院诊治胰腺囊性疾病的临床资料和手术治疗随访结果。结合病理分类的进展讨论胰腺囊性病变的外科诊治决策和趋势。结果共161例胰腺囊性病变病人接受手术治疗并有完整记录。术后病理诊断:胰腺假性囊肿24例(14.9%)、先天性囊肿19例(11.8%)、浆液性囊腺瘤/癌30例(18.6%)、黏液性囊腺瘤/癌18例(11.2%)、导管内乳头状黏液瘤/癌31例(19.3%)和实性假乳头状瘤/癌39例(24.2%)。无围手术期死亡病例,术后胰瘘发生率为46.0%(A级19.2%、B级25.5%、C级1.2%)。结论部分胰腺囊性病变有恶性肿瘤倾向,专业化诊治非常重要。腹部B超和CT、MRI检查具有特征性表现,是有效的诊断方法。首选手术切除是安全有效的治疗手段,尤其是术前疑为胰腺黏液性囊腺瘤、导管内乳头状黏液样瘤和实性假乳头状瘤者。
Objective To investigate the diagnosis and treatment of pancreatic cystic tumors. Methods The clinical data and surgical treatment follow-up results of diagnosis and treatment of pancreatic cystic disease in Huashan Hospital affiliated to Fudan University from 2002 to 2012 were retrospectively reviewed. Combined with the progress of pathological classification of pancreatic cystic lesions surgical diagnosis and treatment decisions and trends. Results A total of 161 cases of pancreatic cystic disease patients undergoing surgery and a complete record. Postoperative pathological diagnosis: pancreatic pseudocyst in 24 cases (14.9%), congenital cyst in 19 cases (11.8%), serous cystadenoma / carcinoma in 30 cases (18.6%), mucinous cystadenoma / carcinoma in 18 cases 11.2%), ductal papillary myxoma / carcinoma in 31 cases (19.3%) and solid pseudopapillary tumor / carcinoma in 39 cases (24.2%). There were no perioperative deaths. The incidence of postoperative pancreatic fistula was 46.0% (A grade 19.2%, B grade 25.5%, C grade 1.2%). Conclusion Some pancreatic cystic lesions have the tendency of malignant tumors, and specialized diagnosis and treatment is very important. Abdominal ultrasound and CT, MRI examination has a characteristic manifestation, is an effective diagnostic method. The preferred surgical resection is a safe and effective treatment, especially preoperative suspected pancreatic mucinous cystadenoma, ductal papillary mucinous tumor and solid pseudopapillary tumor.