胰腺囊性病变的临床特征和诊治分析
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摘要
背景:随着影像学技术的进步,胰腺囊性病变的检出率逐年升高,但鉴别不同类型的胰腺囊性病变仍是临床的棘手问题。目的:分析胰腺囊性病变的临床特征和诊治方法。方法:纳入2003年1月~2013年1月上海交通大学附属第一人民医院收治的胰腺囊性病变患者,对入组患者的临床表现、实验室检查、影像学特征以及治疗方法进行回顾性分析。结果:共49例患者纳入研究,其中假性囊肿13例、潴留囊肿4例、先天性囊肿2例、浆液性囊性肿瘤(SCN)9例、黏液性囊性肿瘤(MCN)11例、导管内乳头状黏液性肿瘤(IPMN)7例、实性-假乳头状肿瘤(SPN)3例。49例患者中16例患者无症状,其余33例患者表现为腹痛、腹胀、恶心、呕吐、发热等。13例胰腺假性囊肿患者均有急、慢性胰腺炎或外伤病史,3例IPMN患者血清CA19-9升高。B超、CT、MRI/MRCP、EUS诊断胰腺囊性病变的准确率分别为24.5%、32.7%、61.1%、100%。49例患者均接受手术治疗,分别行内引流术、囊肿切除术、胰十二指肠切除术、胰体(尾)切除术以及节段性胰腺切除术。结论:胰腺囊性病变无特异性临床表现。CT、MRI/MRCP作为无创检查手段,应广泛用于囊性病变的诊断和评估,EUS可作为进一步检查手段。选择合理的手术方案是治疗胰腺囊性病变的关键。
Background:With the technical development of image modalities,the detection rate of pancreatic cystic lesion is increasing in recent years.However,the differential diagnosis of pancreatic cystic lesion remains difficult in clinical practice.Aims;To investigate the clinical feature,diagnosis and treatment of pancreatic cystic lesion.Methods;A retrospective analysis was conducted on clinical manifestation,laboratory examination,imaging feature and treatment of patients with pancreatic cystic lesion who were enrolled from Jan.2003 to Jan.2013 at Shanghai First People' s Hospital,Shanghai Jiaotong University.Results;A total of 49 eligible subjects were enrolled in this investigation,in which 13 cases were pancreatic pseudocyst,4 cases were retention cyst,2 cases were congenital cyst,9 cases were serous cystic neoplasm(SCN),11 cases were mucinous cystic neoplasm(MCN),7 cases were intraductal papillary mucinous neoplasm(IPMN)and 3 cases were solid-pseudopapillary neoplasm(SPN).Among the 49 cases,16 had no symptoms,and the remaining 33had complaints of abdominal pain,abdominal distension,nausea,vomit and fever.All cases with pancreatic pseudocyst had history of acute or chronic pancreatitis or trauma.Three cases with IPMN had elevated serum CA19-9.The diagnostic accuracy rates of B ultrasound,CT,MRI/MRCP and EUS were 24.5%,32.7%,61.1%and 100%,respectively.All cases received operation including internal drainage,cystectomy,pancreaticoduodenectomy,pancreatectomy and segmental pancreatectomy.Conclusions;Pancreatic cystic lesion has no special and typical clinical manifestations.CT and MRI/MRCP are noninvasive imaging modalities,which should be extensively used to detect and evaluate the cystic lesion.EUS could provide additional information of cystic lesion,while CT or MRI has certain limitations.Selecting proper surgical intervention is a key for the treatment of pancreatic cystic lesion.
Background:With the technical development of image modalities,the detection rate of pancreatic cystic lesion is increasing in recent years.However,the differential diagnosis of pancreatic cystic lesion remains difficult in clinical practice.Aims;To investigate the clinical feature,diagnosis and treatment of pancreatic cystic lesion.Methods;A retrospective analysis was conducted on clinical manifestation,laboratory examination,imaging feature and treatment of patients with pancreatic cystic lesion who were enrolled from Jan.2003 to Jan.2013 at Shanghai First People' s Hospital,Shanghai Jiaotong University.Results;A total of 49 eligible subjects were enrolled in this investigation,in which 13 cases were pancreatic pseudocyst,4 cases were retention cyst,2 cases were congenital cyst,9 cases were serous cystic neoplasm(SCN),11 cases were mucinous cystic neoplasm(MCN),7 cases were intraductal papillary mucinous neoplasm(IPMN)and 3 cases were solid-pseudopapillary neoplasm(SPN).Among the 49 cases,16 had no symptoms,and the remaining 33had complaints of abdominal pain,abdominal distension,nausea,vomit and fever.All cases with pancreatic pseudocyst had history of acute or chronic pancreatitis or trauma.Three cases with IPMN had elevated serum CA19-9.The diagnostic accuracy rates of B ultrasound,CT,MRI/MRCP and EUS were 24.5%,32.7%,61.1%and 100%,respectively.All cases received operation including internal drainage,cystectomy,pancreaticoduodenectomy,pancreatectomy and segmental pancreatectomy.Conclusions;Pancreatic cystic lesion has no special and typical clinical manifestations.CT and MRI/MRCP are noninvasive imaging modalities,which should be extensively used to detect and evaluate the cystic lesion.EUS could provide additional information of cystic lesion,while CT or MRI has certain limitations.Selecting proper surgical intervention is a key for the treatment of pancreatic cystic lesion.
引文
1 Kim KO,Kim TN.Acute pancreatic pseudocyst:incidence,risk factors,and clinical outcomes[J].Pancreas,2012,41(4):577-581.
2 Farrell JJ,Fern6ndez-del Castillo C.Pancreatic cystic neoplasms:management and unanswered questions[J].Gastroenterology,2013,144(6).1303-1315.
3 Fritz S,Hackert T,Hinz U,et al.Role of serum carbohydrate antigen 19-9 and carcinoembryonic antigen in distinguishing between benign and invasive intraductal papillary mucinous neoplasm of the pancreas[J].Br J Surg,2011,98(1):104-110.
4 Sahani DV,Kadavigere R,Blake M,et al.Intraductal papillary mucinous neoplasm of pancreas;multi-detector row CT with 2D curved reformations—correlation with MRCP[J].Radiology,2006,238(2):560-569.
5 Bassi C,Salvia R,Molinari E,et al.Management of 100consecutive cases of pancreatic serous cystadenoma;wait for symptoms and see at imaging or vice versa[J]?World J Surg,2003,27(3):319-323.
6 Procacci C,Biasiutti C,Carbognin G,et al.Characterization of cystic tumors of the pancreas;CT accuracy[J].J Comput Assist Tomogr,1999,23(6):906-912.
7 Petrone MC,Arcidiacono PG.Role of endosocopic ultrasound in the diagnosis of cystic tumours of the pancreas[J].Dig Liver Dis,2008,40(11):847-853.
8 Maguchi H.The roles of endoscopic ultrasonography in the diagnosis of pancreatic tumors[J].J Hepatobiliary Pancreat Surg,2004,11(1):1-3.
9 Ahmad NA,Kochman ML,Brensinger C,et al.Interobserver agreement among endosonographers for the diagnosis of neoplastic versus non-neoplastic pancreatic cystic lesions[J].Gastrointest Endosc,2003,58(1):59-64.
10 Long EE,Van Dam J,Weinstein S,et al.Computed tomography,endoscopic,laparoscopic,and intra-operative sonography for assessing resectability of pancreatic cancer[J].Surg Oncol,2005,14(2):105-113.
11 Barthet M,Lamblin G,Gasmi M,et al.Clinical usefulness of a treatment algorithm for pancreatic pseudocysts[J].Gastrointest Endosc,2008,67(2):245-252.
12 Cooperman AM.Surgical treatment of pancreatic pseudocysts[J].Surg Clin North Am,2001,81(2):411-419.
13 Tanaka M,Fernandez-del Castillo C,Adsay V,et al.International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas[J].Pancreatology,2012,12(3):183-197.
14 Turner BG,Brugge WR.Pancreatic cystic lesions;when to watch,when to operate,and when to ignore[J].Curr Gastroenterol Rep,2010,12(2):98-105.
15 Jani N,Bani Hani M,Schulick RD,et al.Diagnosis and management of cystic lesions of the pancreas[J].Diagn Ther Endosc,2011,2011:478913.
2 Farrell JJ,Fern6ndez-del Castillo C.Pancreatic cystic neoplasms:management and unanswered questions[J].Gastroenterology,2013,144(6).1303-1315.
3 Fritz S,Hackert T,Hinz U,et al.Role of serum carbohydrate antigen 19-9 and carcinoembryonic antigen in distinguishing between benign and invasive intraductal papillary mucinous neoplasm of the pancreas[J].Br J Surg,2011,98(1):104-110.
4 Sahani DV,Kadavigere R,Blake M,et al.Intraductal papillary mucinous neoplasm of pancreas;multi-detector row CT with 2D curved reformations—correlation with MRCP[J].Radiology,2006,238(2):560-569.
5 Bassi C,Salvia R,Molinari E,et al.Management of 100consecutive cases of pancreatic serous cystadenoma;wait for symptoms and see at imaging or vice versa[J]?World J Surg,2003,27(3):319-323.
6 Procacci C,Biasiutti C,Carbognin G,et al.Characterization of cystic tumors of the pancreas;CT accuracy[J].J Comput Assist Tomogr,1999,23(6):906-912.
7 Petrone MC,Arcidiacono PG.Role of endosocopic ultrasound in the diagnosis of cystic tumours of the pancreas[J].Dig Liver Dis,2008,40(11):847-853.
8 Maguchi H.The roles of endoscopic ultrasonography in the diagnosis of pancreatic tumors[J].J Hepatobiliary Pancreat Surg,2004,11(1):1-3.
9 Ahmad NA,Kochman ML,Brensinger C,et al.Interobserver agreement among endosonographers for the diagnosis of neoplastic versus non-neoplastic pancreatic cystic lesions[J].Gastrointest Endosc,2003,58(1):59-64.
10 Long EE,Van Dam J,Weinstein S,et al.Computed tomography,endoscopic,laparoscopic,and intra-operative sonography for assessing resectability of pancreatic cancer[J].Surg Oncol,2005,14(2):105-113.
11 Barthet M,Lamblin G,Gasmi M,et al.Clinical usefulness of a treatment algorithm for pancreatic pseudocysts[J].Gastrointest Endosc,2008,67(2):245-252.
12 Cooperman AM.Surgical treatment of pancreatic pseudocysts[J].Surg Clin North Am,2001,81(2):411-419.
13 Tanaka M,Fernandez-del Castillo C,Adsay V,et al.International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas[J].Pancreatology,2012,12(3):183-197.
14 Turner BG,Brugge WR.Pancreatic cystic lesions;when to watch,when to operate,and when to ignore[J].Curr Gastroenterol Rep,2010,12(2):98-105.
15 Jani N,Bani Hani M,Schulick RD,et al.Diagnosis and management of cystic lesions of the pancreas[J].Diagn Ther Endosc,2011,2011:478913.