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目的总结本中心收治的胰腺囊性肿瘤(PCN)的诊治情况及预后,为PCN的临床处理提供一定依据。方法回顾性分析2005年1月至2016年10月南京鼓楼医院收治的PCN病例,分析各类PCN的临床特征、超声内镜下表现、治疗方式及预后情况。结果本研究共纳入222例PCN病例,包括94例导管内乳头状黏液瘤(IPMN),58例黏液性囊性肿瘤(MCN),43例浆液性囊性肿瘤(SCN)及27例实性假乳头状肿瘤(SPN)。各型PCN患者的男女比例1∶1.55,平均年龄为(56.0±15.7)岁,大部分PCN患者(64.0%,142/222)在就诊时有临床表现,其中以腹痛最常见(47.3%,105/222)。各型PCN术后病理提示分别有7例IPMN(16.3%,7/43)和5例MCN(9.1%,5/55)为恶性(伴浸润性癌或重度异型增生),而SCN和SPN术后病理均为良性(P=0.027)。未手术的PCN患者中,分别有4例IPMN(8.3%,4/48)和2例SPN(66.7%,2/3)在随访过程中发生癌变。获随访的188例PCN患者的5年生存率为86.0%。124例PCN患者术后的5年生存率为90.0%,SCN、MCN和SPN的术后5年生存率分别为100.0%、92.1%和93.8%,而IPMN仅为74.0%,差异有统计学意义(P=0.003)。结论PCN好发于中年女性,大部分患者就诊时有临床症状,最常表现为腹痛。MCN、IPMN和SPN具有恶变倾向,应在符合手术条件的情况下行手术切除;而SCN则可采取保守治疗。各类PCN预后差异显著,IPMN预后最差,MCN、SCN及SPN术后预后均较好。
Objective To summarize the diagnosis and treatment of pancreatic cystic neoplasm (PCN) admitted to our center and its prognosis, and to provide a basis for clinical treatment of PCN. Methods The clinical data of PCN from January 2005 to October 2016 in Nanjing Drum Tower Hospital were retrospectively analyzed. The clinical features, the performance, the treatment and the prognosis of PCN were analyzed. Results A total of 222 PCN cases were enrolled in this study, including 94 cases of ductal papillary myxoma (IPMN), 58 cases of mucinous cystic neoplasm (MCN), 43 cases of serous cystic neoplasm (SCN) and 27 cases of real leave Papillary tumor (SPN). The average age was (56.0 ± 15.7) years. The majority of PCN patients (64.0%, 142/222) had clinical symptoms at the time of visit, of which the most common was abdominal pain (47.3%, 105 / 222). Pathological findings of various types of PCN showed that IPMN (16.3%, 7/43), and 5 cases of MCN (9.1%, 5/55) were malignant (with invasive carcinoma or severe dysplasia) Pathology was benign (P = 0.027). Four cases of IPMN (8.3%, 4/48) and two cases of SPN (66.7%, 2/3), respectively, were found to be cancerous during the follow-up after surgery in patients without PCOS. The 5-year survival rate of the 188 PCN patients who were followed up was 86.0%. The 5-year survival rate of 124 patients with PCN was 90.0%. The 5-year survival rates of SCN, MCN and SPN were 100.0%, 92.1% and 93.8%, respectively, while the IPMN was 74.0%, the difference was statistically significant (P = 0.003). Conclusion PCN occurs in middle-aged women, most of the patients with clinical symptoms at presentation, the most common manifestation of abdominal pain. MCN, IPMN, and SPN have a tendency to become malignant and should be surgically removed under surgical conditions, while SCN can be conservative. The prognosis of various types of PCN significant difference, IPMN worst prognosis, MCN, SCN and SPN postoperative prognosis are good.