单中心77例胰腺浆液性囊腺瘤回顾性统计分析及研究

发布时间：2018-06-27 02:04

本文选题：浆液性囊腺瘤 + 胰腺　；参考：《浙江大学》2017年硕士论文

【摘要】：目的:胰腺浆液性囊腺瘤(serous cystic neoplasms,SCNs)术前诊断仍然是临床工作中的难题,本文旨在分析其临床特点、影像学检查、治疗方法和预后情况,从而提高术前诊断,减少不必要的手术治疗,为本病的治疗提供指导。方法:收集浙江大学医学院附属第一医院2005年1月至2016年12月经手术切除和病理证实确诊为胰腺浆液性囊腺瘤的77例患者的临床资料,回顾性分析住院病史、临床表现(症状和体征)、实验室检查、影像学结果、术前诊断、治疗(术式、并发症等)、病理结果、复查随访等资料并查阅相关文献进行总结。结果:77例病理诊断为浆液性囊腺瘤的患者中,女性64例,男性13例,中位年龄53岁(22-82岁)。33例合并临床症状如腹痛、腰背痛、恶心呕吐、黄疸等,腹痛为最常见症状,剩余患者因体检发现,病程最短2天,最长12年。胰体尾部肿瘤平均大小大于胰颈部(P=0.008)。2例CA125升高,5例CA199升高,8例铁蛋白升高。76例行B超检查,病灶检出率为96.05%,大致诊断率为38.16%,无明确诊断;69例行CT检查,病灶检出率为98.55%,大致诊断率为52.17%,确诊率为5.80%;37例行MRI检查,病灶检出率为97.30%,大致诊断率为59.46%,确诊率为5.4%,23例行MRCP检查,病灶检出率为86.95%,大致诊断率为21.74%,确诊率为4.35%;14例行EUS检查,病灶检出率为100%,大致诊断率为57.14%,确诊率为35.71%。EUS和MRI在囊腺瘤诊断率方面高于B超(p0.05)。B超联合CT检查大致诊断率为98.53%,CT联合EUS的大致诊断率为100%,确诊率为62.5%,CT联合MRI大致诊断率为96.55%,确诊率为10.34%,MRI联合EUS大致诊断率85.5%,确诊率50%。19例行胰十二指肠切除术,12例行胰腺中段切除术,19例行胰体尾联合脾脏切除术,19例行保留脾脏胰体尾切除术,8例行胰腺肿块剜除术。18例患者发生胰漏,胰漏与手术方式无关。结合手术记录及术后病理显示肿瘤19例位于胰头,42例位于胰体尾,16例位于胰颈。根据病理以及结合影像学,56例为微囊型,9例为寡囊型,9例为混合型,3例为实性。63例患者获得随访,中位随访时间39.99月,4例患者因其他疾病死亡,7例术后新发糖尿病,所有患者均无复发或癌变。结论:1.胰腺浆液性囊腺瘤起病隐匿,多数无特异性临床表现、肿瘤标志物升高,无胰腺炎病史和黄疸等浸润表现,好发于中年女性。2.B超、CT、MRI和EUS均有较高的病灶检出率,CT和MRI表现有一定的特征性,有较高的大致诊断率,EUS有较高的诊断率。B超联合CT后有较高的大致诊断率,CT或MR[联合EUS.可显著提高大致诊断率和确诊率,建议采取B超筛查病灶,通过CT/MRI进一步诊断。3.浆液性囊腺瘤好发于胰体尾部,病理分型以微囊型为主,是一种良性肿瘤,术后恢复良好,极少复发或恶变。4.在治疗上,认为有症状以及术前无法排除恶性可能的病人需要积极手术。根据不同特征选择合理的手术方式,完整切除肿瘤的同时保留更多的正常组织和器官,从而减少术后并发症提高生活质量。
[Abstract]:Objective: preoperative diagnosis of pancreatic serous cystadenoma (serous cystic neoplasms) is still a difficult problem in clinical work. The purpose of this article is to analyze its clinical characteristics, imaging examination, treatment methods and prognosis, so as to improve the preoperative diagnosis. Reduce unnecessary surgical treatment and provide guidance for the treatment of this disease. Methods: the clinical data of 77 patients with pancreatic serous cystadenoma confirmed by surgery and pathology from January 2005 to December 2016 in the first affiliated Hospital of Zhejiang University Medical College were collected and analyzed retrospectively. Clinical manifestations (symptoms and signs), laboratory examination, imaging results, preoperative diagnosis, treatment (operation, complications, etc.), pathological findings, follow-up and other data were reviewed and reviewed. Results among 77 cases of serous cystadenoma diagnosed by pathology, 64 cases were female, 13 cases were male, the median age was 53 years (22-82 years) .33 cases with clinical symptoms such as abdominal pain, low back pain, nausea and vomiting, jaundice, etc., abdominal pain was the most common symptom. The remaining patients were found to have a shortest course of disease of 2 days and a maximum of 12 years due to physical examination. The mean size of tumors in the body and tail of pancreas was larger than that in the neck of pancreas (P < 0.008). The mean size of CA125 was larger than that in the neck of pancreas (P < 0.008). 5 cases were elevated in CA199 and 8 cases were elevated ferritin. 76 cases were examined by B-ultrasound. The detection rate of lesions was 96.05 and the approximate diagnostic rate was 38.16. No definite diagnosis was made in 69 cases of CT. The detection rate of lesions was 98.55 and the approximate diagnostic rate was 52.17. The diagnostic rate was 5.80 and 37 cases MRI examination. The detection rate of lesions was 97.30. The approximate diagnostic rate was 59.46. The diagnostic rate was 5.445%. The diagnostic rate was 86.955.The overall diagnostic rate was 21.74%, and the diagnostic rate was 4.3510% in 14 cases of EUS examination. The detection rate of lesions was 100 and the approximate diagnostic rate was 57.14. The diagnostic rate of cystadenoma was 35.71. EUS and MRI were higher than that of B-ultrasound (p0.05). The approximate diagnostic rate of CT combined with EUS was 98.533.The diagnostic rate of CT combined with EUS was 100, and the diagnostic rate of CT combined with MRI was 62.5%. The diagnostic rate of MRI combined with EUS was 85. 5%. The diagnostic rate was 50. 19 cases with pancreatoduodenectomy and 12 cases with middle pancreatectomy and 19 cases with pancreatectomy combined with splenectomy. 19 cases with splenic body and tail resection and 19 cases with splenic body and tail excision. Pancreatic leakage occurred in 18 patients undergoing enucleation of pancreatic masses. Pancreatic leakage has nothing to do with the operative method. Combined with surgical records and postoperative pathology, 19 cases were located in the head of pancreas, 42 cases were located in the body and tail of the pancreas, 16 cases were located in the neck of the pancreas. According to the pathological and imaging findings of 56 cases of microcapsule type 9 cases of oligocapsule type 9 cases of mixed type 3 cases of solid. 63 cases were followed up. The median follow-up time was 39. 9 months and 4 cases died of other diseases. No recurrence or canceration was found in all patients. Conclusion 1. Most of the pancreatic serous cystadenomas had no specific clinical manifestations, increased tumor markers, no history of pancreatitis and jaundice, etc. The detection rate of CT and EUS in CT and EUS were higher than those in middle aged women. The CT and MRI findings were characteristic, and the diagnostic rate of EUS was higher than that of EUS. The diagnostic rate of CT or Mr [combined with EUSUS] was higher than that of B-ultrasonography combined with CT. It is suggested that B-mode ultrasound should be used to screen the lesions and further diagnose .3by CT / MRI. Serous cystadenoma usually occurs in the tail of the pancreatic body. The pathological type is mainly microencapsulated. It is a benign tumor with good recovery after operation and few recurrence or malignancy. 4. In treatment, patients who are symptomatic and who cannot rule out the possibility of malignancy need active surgery. According to different characteristics, reasonable operation methods were selected, and more normal tissues and organs were retained while tumor was removed completely, so as to reduce postoperative complications and improve quality of life.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.9

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