胰腺实性假乳头状瘤36例诊断与治疗
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摘要
目的总结胰腺实性假乳头状瘤(solid pseudopapillary tumor of the pancreas,SPTP)的诊断与治疗经验。方法回顾性分析湖南省人民医院胰脾外科2012年1月至2017年1月收治的36例经术后病理证实的SPTP临床病例资料,并对其进行随访。结果本组患者中男10例,女26例,年龄12~57岁,平均32岁。36例患者中,SPTP发生于胰头14例(38.89%),胰颈2例(5.56%),胰体尾20例(55.56%)。术前诊断主要依赖于彩超、CT、MRI等影像学检查,特别是CT检查。肿瘤直径平均(6.3±2.6)cm。患者均行手术切除治疗,其中行胰十二指肠切除术10例(其中腔镜下施行6例),保留幽门胰十二指肠切除术1例,胰体尾切除+脾脏切除术8例(其中腔镜下施行4例),保留脾脏的胰体尾切除术12例(其中腔镜下施行8例),胰腺中段切除+胰肠内引流术2例,肿块局部切除+胰肠内引流术3例。随访时间3个月~5年,所有患者均获得随访,一般情况良好,均无糖尿病、腹泻、消化不良等胰腺功能减退情况发生,均未发现复发和转移,无死亡。结论 SPTP是一种少见的低度恶性胰腺肿瘤,CT上的典型表现对于该病的诊断有帮助,但确诊仍有赖于病理组织学检查。完整手术切除可获得较好的预后,微创化的手术和快速康复理念的实施能让患者获益。
Objective To evaluate the diagnosis and treatment of solid pseudopapillary tumor of the pancreas(SPTP). Methods From Jan. 2012 to Jan. 2017, the clinical data of 36 SPTP patients diagnosed and surgically treated at Hunan Provincial People's Hospital was analyzed retrospectively, and all of them were followed-up. Results There were 10 men and 26 women patients, the median age was 32 years old, with a range from 12 to 57 years. The most common tumor localization was at the pancreatic body and tail(20 patients, 55.56%), followed by the pancreatic head(14 patients, 38.89%), and the pancreatic neck(1 patient, 5.56%). Clinical symptoms were nonspecific and the preoperative diagnosis of SPTP depended on imaging study, such as ultrasonography, CT and MRI, especially CT. The mean diameter of the tumor was(6.3±2.6) cm. All the patients were treated surgically. Eight patients were treated with pancreaticoduodenectomy(6 patients were processed in laparoscopy), 1 patient with pylorus-preserving pancreaticoduodenectomy, 8 patients with distal pancreatectomy(4 patients were processed in laparoscopy), 12 patients with spleen-preserving distal pancreatectomy(8 patients were processed in laparoscopy), and 1 patient was done with middle segmental pancreatic resection, 3 patients with focal pancreatic resection. All the correct diagnosis were made according to the pathology after surgery. In a follow-up ranging from 3 months to 5 years, all the cases were alive with no evidence of disease recurrence. Conclusion SPTP is a less common neoplasm with low-grade malignancy, CT is an effective diagnosis method for SPTP, but the final diagnosis dependeds on the pathology results. Complete tumor resection results in satisfactory prognosis, the application of minimally invasive surgery and fast track surgery benefit the patients.
Objective To evaluate the diagnosis and treatment of solid pseudopapillary tumor of the pancreas(SPTP). Methods From Jan. 2012 to Jan. 2017, the clinical data of 36 SPTP patients diagnosed and surgically treated at Hunan Provincial People's Hospital was analyzed retrospectively, and all of them were followed-up. Results There were 10 men and 26 women patients, the median age was 32 years old, with a range from 12 to 57 years. The most common tumor localization was at the pancreatic body and tail(20 patients, 55.56%), followed by the pancreatic head(14 patients, 38.89%), and the pancreatic neck(1 patient, 5.56%). Clinical symptoms were nonspecific and the preoperative diagnosis of SPTP depended on imaging study, such as ultrasonography, CT and MRI, especially CT. The mean diameter of the tumor was(6.3±2.6) cm. All the patients were treated surgically. Eight patients were treated with pancreaticoduodenectomy(6 patients were processed in laparoscopy), 1 patient with pylorus-preserving pancreaticoduodenectomy, 8 patients with distal pancreatectomy(4 patients were processed in laparoscopy), 12 patients with spleen-preserving distal pancreatectomy(8 patients were processed in laparoscopy), and 1 patient was done with middle segmental pancreatic resection, 3 patients with focal pancreatic resection. All the correct diagnosis were made according to the pathology after surgery. In a follow-up ranging from 3 months to 5 years, all the cases were alive with no evidence of disease recurrence. Conclusion SPTP is a less common neoplasm with low-grade malignancy, CT is an effective diagnosis method for SPTP, but the final diagnosis dependeds on the pathology results. Complete tumor resection results in satisfactory prognosis, the application of minimally invasive surgery and fast track surgery benefit the patients.
引文
[1]Frantz VK.Tumors of the pancreas.In:Atlas of Tumor Pathology[M].Washington DC:Armed forces Institute of Pathology,1959:32-33.
[2]Crawford BE 2nd.Solid and papillary epithelial neoplasm of the pancreas,diagnosis by cytology[J].South Med J,1998,91(10):973-977.
[3]中华医学会外科学分会胰腺外科学组.胰腺术后外科常见并发症预防及治疗的专家共识(2010)[J].中华外科杂志,2010,48(18):1365-1368.
[4]Leggio S,Orofino A,Anzillotto MP,et al.Solid pseudopapillary tumors of the pancreas.Case report and review of the literature[J].Ann Ital Chir,2014,85(85):1166-1166.
[5]Butte JM,Brennan MF,Gonen M,et al.Solid pseudopapillary tumors of the pancreas:clinical features,surgical outcomes,and long-term survival in 45 consecutive patients from a single center[J].J Gastoinest Surg,2011,15(2):350-357.
[6]Papavramidis T,Papavramidis S.Solid pseudopapillary tumors of the pancreas:review of 718 patients in English literature[J].J Am Coll Surg,2005,200(6):965-972.
[7]Kosmahl M,Seada LS,Janig U,et al.Solid-pseudopapillary tumor of the pancreas:its origin revisited[J].Virchows Arch,2000,436(5):473-480.
[8]Machado MC,Machado MA,Bacchella T,et al.Solid pseudopapillary neoplasm of the pancreas:distinct patterns of onset,diagnosis,and prognosis for male versus female patients[J].Surgery,2008,143(11):29-34.
[9]宋彬,胡先贵,金钢,等.胰腺实性假乳头状肿瘤40例诊治分析[J].中华外科杂志,2010,48(8):625-626.
[10]尹勇,李兆丽,王勍,等.胰腺实性假乳头状瘤的国内文献荟萃分析[J].中华胰腺病杂志,2010,10(5):341-344.
[11]龙江,罗国培,金凯舟,等.胰腺实性假乳头状瘤的超声表现[J].中国癌症杂志,2014,24(9):676-678.
[12]徐钟慧,姜玉新,欧阳云淑,等.胰腺实性假乳头状瘤的超声表现[J].中华超声影像学杂志,2007,16(3):233-235.
[13]Edigara G,Nihal A,Ravindranath MM.Solid pseudopapillary tumor of the pancreas[J].Int J Health&Allied Sci,2016,4(2):103-107.
[14]王力,梁寒,王晓娜,等.胰腺实性假乳头状瘤的诊断与治疗[J].中华普通外科杂志,2012,27(11):913-915.
[15]陈永亮,黄志强,董家鸿,等.胰腺实性假乳头状瘤58例手术治疗及预后分析[J].中华外科杂志,2012,50(7):615-617.
[16]Butte JM,Brennan MF,G?nen M,et al.Solid pseudopapillary tumors of the pancreas.Clinical features,surgical outcomes,and long-term survival in 45 consecutive patients from a single center[J].J Gastro Surg,2011,15(2):350-357.
[17]Nikolaos V,Abbas A,Peter K,et al.Solid-pseudopapillary neoplasm(SPN)of the pancreas:case series and literature review on an enigmatic entity[J].Int J Clin Exp Pathol,2013,6(6):1051-1059.
[18]Martin RC,Klimstra DS,Brennan MF,et al.Solid pseudopapillary tumor of the pancreas:a surgical enigma?[J].Ann Surg Oncol,2002,9(1):35-40.
[19]Yu PF,Hu ZH,Wang XB,et al.Solid pseudopapillary tumor of the pancreas:a review of 553 cases in Chinese literature[J].World J Gastroenterol,2010,16(10):1209-1214.
[20]殷涛,王春友,熊炯炘,等.胰腺实性假乳头状瘤的诊断和外科治疗[J].中华肝胆外科杂志,2009,15(12):888-890.
[21]张鹏,于聪慧,许春伟.胰腺实性假乳头状瘤25例临床分析[J].肝胆胰外科杂志,2014,26(2):117-120.
[2]Crawford BE 2nd.Solid and papillary epithelial neoplasm of the pancreas,diagnosis by cytology[J].South Med J,1998,91(10):973-977.
[3]中华医学会外科学分会胰腺外科学组.胰腺术后外科常见并发症预防及治疗的专家共识(2010)[J].中华外科杂志,2010,48(18):1365-1368.
[4]Leggio S,Orofino A,Anzillotto MP,et al.Solid pseudopapillary tumors of the pancreas.Case report and review of the literature[J].Ann Ital Chir,2014,85(85):1166-1166.
[5]Butte JM,Brennan MF,Gonen M,et al.Solid pseudopapillary tumors of the pancreas:clinical features,surgical outcomes,and long-term survival in 45 consecutive patients from a single center[J].J Gastoinest Surg,2011,15(2):350-357.
[6]Papavramidis T,Papavramidis S.Solid pseudopapillary tumors of the pancreas:review of 718 patients in English literature[J].J Am Coll Surg,2005,200(6):965-972.
[7]Kosmahl M,Seada LS,Janig U,et al.Solid-pseudopapillary tumor of the pancreas:its origin revisited[J].Virchows Arch,2000,436(5):473-480.
[8]Machado MC,Machado MA,Bacchella T,et al.Solid pseudopapillary neoplasm of the pancreas:distinct patterns of onset,diagnosis,and prognosis for male versus female patients[J].Surgery,2008,143(11):29-34.
[9]宋彬,胡先贵,金钢,等.胰腺实性假乳头状肿瘤40例诊治分析[J].中华外科杂志,2010,48(8):625-626.
[10]尹勇,李兆丽,王勍,等.胰腺实性假乳头状瘤的国内文献荟萃分析[J].中华胰腺病杂志,2010,10(5):341-344.
[11]龙江,罗国培,金凯舟,等.胰腺实性假乳头状瘤的超声表现[J].中国癌症杂志,2014,24(9):676-678.
[12]徐钟慧,姜玉新,欧阳云淑,等.胰腺实性假乳头状瘤的超声表现[J].中华超声影像学杂志,2007,16(3):233-235.
[13]Edigara G,Nihal A,Ravindranath MM.Solid pseudopapillary tumor of the pancreas[J].Int J Health&Allied Sci,2016,4(2):103-107.
[14]王力,梁寒,王晓娜,等.胰腺实性假乳头状瘤的诊断与治疗[J].中华普通外科杂志,2012,27(11):913-915.
[15]陈永亮,黄志强,董家鸿,等.胰腺实性假乳头状瘤58例手术治疗及预后分析[J].中华外科杂志,2012,50(7):615-617.
[16]Butte JM,Brennan MF,G?nen M,et al.Solid pseudopapillary tumors of the pancreas.Clinical features,surgical outcomes,and long-term survival in 45 consecutive patients from a single center[J].J Gastro Surg,2011,15(2):350-357.
[17]Nikolaos V,Abbas A,Peter K,et al.Solid-pseudopapillary neoplasm(SPN)of the pancreas:case series and literature review on an enigmatic entity[J].Int J Clin Exp Pathol,2013,6(6):1051-1059.
[18]Martin RC,Klimstra DS,Brennan MF,et al.Solid pseudopapillary tumor of the pancreas:a surgical enigma?[J].Ann Surg Oncol,2002,9(1):35-40.
[19]Yu PF,Hu ZH,Wang XB,et al.Solid pseudopapillary tumor of the pancreas:a review of 553 cases in Chinese literature[J].World J Gastroenterol,2010,16(10):1209-1214.
[20]殷涛,王春友,熊炯炘,等.胰腺实性假乳头状瘤的诊断和外科治疗[J].中华肝胆外科杂志,2009,15(12):888-890.
[21]张鹏,于聪慧,许春伟.胰腺实性假乳头状瘤25例临床分析[J].肝胆胰外科杂志,2014,26(2):117-120.