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目的 :分享胰腺囊性病变的外科诊治经验,探讨胰腺囊性肿瘤的外科诊治特点。方法 :2002至2012年收治161例胰腺囊性疾病患者,行胰腺囊性肿瘤手术治疗。分析手术方式的选择及相应并发症的发生,结合病理分类的变革和差异讨论胰腺囊性肿瘤在外科诊治决策上的趋势。结果 :161例中,胰腺囊性病变位于胰头/钩突部74例,颈体尾部87例;行胰十二指肠切除术59例,胰体尾切除术50例,胰腺中段切除术6例,全/残胰切除术4例,胰腺肿瘤局部剜除术18例和囊肿内/外引流术24例。手术标本经病理证实为胰腺假性囊肿、先天性囊肿、浆液性囊腺瘤(癌)、黏液性囊腺瘤(癌)、导管内乳头状黏液样瘤(癌)和实性假乳头状瘤(癌)。无围手术期死亡病例发生,术后胰瘘的总发生率为44.7%(A级19.2%、B级25.5%)。结论 :应充分重视胰腺囊性病变,尤其是胰腺囊性肿瘤。对于胰腺囊性肿瘤中胰腺导管内乳头状黏液样瘤的诊治已是临床研究热点,而其与胰腺黏液性囊腺瘤的鉴别诊断值得进一步深入讨论。
Objective: To share the experience of surgical diagnosis and treatment of pancreatic cystic lesions and discuss the characteristics of surgical diagnosis and treatment of pancreatic cystic tumors. Methods: From 2002 to 2012, 161 patients with pancreatic cystic disease were treated with surgical treatment of pancreatic cystic tumors. Analysis of the choice of surgical approach and the occurrence of the corresponding complications, combined with the changes and differences in pathological classification of pancreatic cystic tumors in surgical diagnosis and treatment of the trend. Results: In 161 cases, cystic pancreatic lesions were located in the pancreas head / hook in 74 cases and in the neck in 87 cases. Pancreaticoduodenectomy in 59 cases, pancreatectomy in the pancreas and tail resection in 50 cases, Cases, pancreas / pancreatectomy in 4 cases, pancreas tumor excision in 18 cases and cyst inside / outside drainage in 24 cases. Surgical specimens confirmed by pathology as pancreatic pseudocyst, congenital cyst, serous cystadenoma (cancer), mucinous cystadenoma (carcinoma), intraductal papillary mucinous carcinoma (carcinoma) and solid pseudopapillary tumor (cancer). No perioperative deaths occurred. The overall incidence of postoperative pancreatic fistula was 44.7% (A grade 19.2%, B grade 25.5%). CONCLUSIONS: Pancreatic cystic lesions should be adequately valued, especially in pancreatic cystic tumors. Diagnosis and treatment of pancreatic ductal papillary mucinous neoplasms in pancreatic cystic neoplasm is a hot topic in clinical research, and its differential diagnosis with pancreatic mucinous cystadenoma is worth further in-depth discussion.