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目的 探讨胰腺假乳头实体上皮瘤的诊断和治疗方法。方法 回顾性分析我院自1994年6月至2 0 0 3年6月收治的2 1例胰腺假乳头实体上皮瘤患者的临床资料。结果 本组中13例以腹痛为主要表现,7例可扪及腹块。影像学检查未能明确诊断。12例肿瘤位于胰头,9例位于胰体尾部。肿瘤平均直径9 5 (3～2 0 )cm。1例合并肝转移。12例胰头肿瘤中4例行胰十二指肠切除术,8例行肿块切除术;9例胰体尾部肿瘤均行胰腺体尾部加脾切除术。14例术中冰冻病理诊断明确,另有3例免疫组化染色结果报告为胰岛素瘤或其他恶性肿瘤,最终由病理切片及免疫组化染色结果明确诊断。免疫组化染色报告15例NSE染色中14例阳性,10例Vimentin染色中8例阳性,8例PAS染色中7例阳性,细胞角蛋白、上皮膜抗原及嗜铬颗粒素A均阴性。18例获随访,中位随访时间2 4 (1～6 0 )个月,均无瘤存活。结论 对年轻女性出现的胰腺巨大肿瘤应高度怀疑胰腺假乳头实体上皮瘤。积极的手术治疗能获得良好的预后。
Objective To investigate the diagnosis and treatment of pancreatic pseudopapillary solid tumors. Methods The clinical data of 21 patients with pancreatic pseudopapillary solid epithelial tumor who were treated in our hospital from June 1994 to June 2003 were retrospectively analyzed. Results The group of 13 cases of abdominal pain as the main performance, palpable abdominal mass in 7 cases. Imaging examination failed to confirm the diagnosis. Twelve of the tumors were located in the head of the pancreas and 9 in the tail of the pancreas. The average tumor diameter of 9 5 (3 ~ 2 0) cm. One patient had liver metastases. In 12 cases of pancreatic head tumors, 4 cases underwent pancreaticoduodenectomy and 8 cases underwent tumor resection. Nine cases of pancreatic body tail tumors were treated with splenectomy plus splenectomy. Fourteen cases of pathological diagnosis of frozen clear, and the other three cases of immunohistochemical results reported as insulinoma or other malignant tumors, the final diagnosis by pathological sections and immunohistochemical staining results. Immunohistochemical staining showed that 14 cases were positive in 15 cases of NSE staining, 8 cases were positive in 10 cases of Vimentin staining, 7 cases were positive in 8 cases of PAS staining, and all were negative for cytokeratin, epithelial membrane antigen and chromogranin A. Eighteen patients were followed up for a median of 24 (1-600) months, with no tumor-free survival. Conclusion Pancreatic pseudopapillary solid epithelial tumors should be highly suspected for the large pancreatic tumors in young women. Positive surgical treatment can get a good prognosis.