胰腺实性假乳头状瘤的诊断和治疗:附8例报告及国内文献资料分析
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石汉平

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Diagnosis and treatment of solid pseudopapillary tumor of pancreas: a report of 8 cases with review of domestic literature
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    摘要:

    目的:分析国内胰腺实性假乳头状瘤(SPTP)的诊疗现状及影响预后的因素。
    方法:回顾性分析收治的8例SPTP和国内报道的397例SPTP的临床、影像、病理特征,并结合临床随访信息评价治疗与预后。
    结果:91.36%的SPTP发生于女性,平均年龄26.76岁,40.99%的患者无主观症状;术前CT在判断肿瘤性质、位置方面较B超准确,肿瘤分布于胰头颈与胰体尾的比例大致相当;手术是主要的治疗方式,3.71%患者术后发生胰瘘;95.40%的患者在一次或二次手术后可获得平均23.5月无病生存,肿瘤进展率5.02%。病理检查是SPTP的确诊方法,免疫组化特征是Vim,AAT,AACT阳性,而Ins,Glu,CEA阴性。此外,笔者收治的62.50%病例合并HBcAb阳性。
    结论:SPTP为主要发生于年轻女性、具有低度恶性潜能的少见肿瘤,术前主要靠CT诊断,术后免疫组化检测可以确诊,手术是主要并且有效的治疗方法,预后受性别、手术方式、肿瘤包膜完整性等因素影响。

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    Abstract:Objective:To study the diagnosis, treatment and prognostic factors of solid and pseudopapillary tumor of the pancreas (SPTP) in domestic.
    Methods :Eight cases with SPTP in our hospital and a review of 397 others from the literature of China were analyzed. Clinical, radiographic and pathologic features were collected, and influence facters of prognosis were evaluated
    Results:The patients (91.36% women) were of mean age 26.76 years; 40.99% of the patients were without subjective symptoms. CT was more precise than ultrasonography in determining tumor nature and location. The tumors were evenly distributed in the head/neck and body/tail of the pancreas. Surgery was the main therapeutic approach; 3.71% patients developed postoperative pancreatic fistula usually after local resection. Pathology was the definitive diagnostic method. Most tumors were positive for vimentin, α-antitrypsin and α-antichymotrysin, while negative for insulin, glucagon and CEA. Disease-free survival of mean 23.5 month was achieved in 95.40% cases after initial or second surgery. Tumor advanced in 5.02% of the patients. In our center, 62.50% of cases had been infected by HBV.
    Conclusions:SPTP mainly occurred in young females and is a potentially low-malignancy tumor. Preoperative diagnosis is made through CT exam and postoperative diagnosis is confirmed by immunochemistry and pathology. Surgery is the predominant and effective method of treatment. Probable prognostic factors include gender, surgical modality and integrity of tumor capsule.

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孙冠青, 陈创奇, 姚嘉茵, 石汉平, 何裕隆, 詹文华.胰腺实性假乳头状瘤的诊断和治疗:附8例报告及国内文献资料分析[J].中国普通外科杂志,2008,17(9):15-907.
DOI:10.7659/j. issn.1005-6947.2008.09.015

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  • 在线发布日期: 2008-09-25