胰腺实性假乳头状瘤32例临床诊疗分析
发布时间：2019-06-29 10:05
【摘要】：目的探讨胰腺实性假乳头状瘤(Solid Pseudopapillary Tumor,SPT)的临床特点、影像学特点、实验室检查、病理学特点、治疗方法和预后情况。方法对郑州大学第一附属医院肝胆胰外科于2010年2月到2017年1月收治的32例SPT患者的临床资料进行回顾性分析并随访,诊断均经过术前穿刺、术中病理或术后病理结果证实,分析总结其临床特点、影像学特点、病理及免疫组化特点、治疗方法及预后情况。结果1.32例患者中男性4例,女性28例,男女比为1:7,女性患者平均年龄29.0±14.16岁,男性患者平均年龄31±13.64岁,女性患者平均年龄低于男性患者平均年龄。2.肿瘤大多数为单发,边界清,最小直径1.5cm,最大直径12.1cm,平均直径5.4cm,多为囊实性。肿瘤可位于胰腺的头部、颈部、体部和尾部,大多位于胰腺尾部。3.患者临床表现大多无明显症状,而有症状者主要表现为腹胀,腹痛和腹部包块。4.术前实验室检查各肿瘤标记物几乎均为阴性,故肿瘤标记物对SPT诊断无特异性。5.影像学检查32例均行CT检查,27例报告为SPT,准确率为84.4%(27/32),12例行MRI检查,9例报告为SPT,准确率75%(9/12)。CT引导下细针穿刺活检6例,术中快速冰冻4例,准确率100%。6.免疫组化中:AAT阳性率100%,CD56阳性率100%,Vimentin阳性率96%,β-catenin阳性率95%,CD10阳性率90%,Cg A阴性率88%,Ki-67≤5%阳性率87%,PR阳性率83%,Syn阳性率78%,CK阳性率74%,CD99阳性率71%,CD34阳性率57%,NSE阳性率50%,可用于诊断SPT。7.32例SPT患者中30例行手术治疗,胰腺肿瘤切除术7例,胰体尾切除术3例,胰体尾(胰尾)+脾脏切除术15例,胰十二指肠切除术4例,剖腹探查术1例。1例发现时已有肝脏多发转移,无法手术,1例为肿瘤自发性破裂出血,行抗休克及止血等保守治疗。术后并发症主要为胰腺假性囊肿和胰瘘,平均住院天数22.5天。术后1例失访,其余31例随访6个月至84个月,无死亡病例,无肿瘤新发及转移。结论1.SPT为好发于年轻女性的少见的胰腺低度恶性肿瘤,虽低度恶性,但仍有远处脏器转移及周围器官侵犯。2.SPT无特异的临床表现,主要症状为腹痛、腹部包块。3.肿瘤标记物对术前诊断无特异性。4.CT及MRI对SPT术前诊断有重要意义,并能对肿瘤的大小、数量、部位、周围有无侵犯提供详细的信息,术前穿刺病理或术中病理结合影像学检查可指导手术方式的选择。5.治疗方法主要是手术治疗,手术完整切除肿瘤后患者预后好,生存期长。
[Abstract]:Objective to investigate the clinical features, imaging features, laboratory examination, pathological features, treatment and prognosis of solid pseudopapidoma of pancreas (Solid Pseudopapillary Tumor,SPT). Methods the clinical data of 32 patients with SPT treated in the Department of Hepatobiliary and Pancreatic surgery, the first affiliated Hospital of Zhengzhou University from February 2010 to January 2017 were analyzed and followed up. The diagnosis was confirmed by preoperative puncture, intraoperative pathology or postoperative pathological results. The clinical features, imaging features, pathological and immunohistochemical features, treatment methods and prognosis were analyzed and summarized. Results 1. Among 32 patients, there were 4 males and 28 females, the ratio of male to female was 1 鈮，
本文编号：2507740
[Abstract]:Objective to investigate the clinical features, imaging features, laboratory examination, pathological features, treatment and prognosis of solid pseudopapidoma of pancreas (Solid Pseudopapillary Tumor,SPT). Methods the clinical data of 32 patients with SPT treated in the Department of Hepatobiliary and Pancreatic surgery, the first affiliated Hospital of Zhengzhou University from February 2010 to January 2017 were analyzed and followed up. The diagnosis was confirmed by preoperative puncture, intraoperative pathology or postoperative pathological results. The clinical features, imaging features, pathological and immunohistochemical features, treatment methods and prognosis were analyzed and summarized. Results 1. Among 32 patients, there were 4 males and 28 females, the ratio of male to female was 1 鈮，
本文编号：2507740
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