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目的:探讨胰腺实性假乳头状瘤的诊断与外科治疗方法。方法:回顾性分析2000年6月—2011年5月间收治的42例胰腺实性假乳头状瘤患者的临床资料。结果:42例中女性41例,男性1例;年龄16~63(平均31.1)岁。肿瘤位于胰头部10例,胰颈部3例,体尾部29例。瘤体最大直径2~15 cm,平均6.3 cm。就诊时无明显症状者20例,仅有上腹部胀痛不适者21例,1例由于肿物破裂出现剧烈腹痛伴发热。超声检查发现胰腺低回声或等回声或囊实混合性包块,CT检查多显示为胰腺区类圆形囊实性肿物,增强后实性部分不同程度强化。患者均行手术切除,经病理证实为胰腺实性假乳头状瘤。其中2例行保留幽门的胰头十二指肠切除术,2例行保留十二指肠的胰头切除术,10例行保留脾脏的胰体尾切除术,13例行胰体尾切除术,14例行局部切除术,1例行姑息切除术。40例患者获随访,随访时间6个月至11年,平均49个月,均存活,无远隔转移病例。1例肿瘤局部切除术后8年局部复发经再次手术局部切除,至今41个月未发现肿瘤复发。结论:年轻女性发生的囊实混合性胰腺肿瘤应高度怀疑胰腺实性假乳头状瘤,该肿瘤为低度恶性,在保证完整切除的前提下尽可能采用保留器官功能的手术方式患者可获长期生存。
Objective: To investigate the diagnosis and surgical treatment of solid pseudopapillary tumor of the pancreas. Methods: The clinical data of 42 patients with solid pseudopapillary pancreatic tumors in our hospital from June 2000 to May 2011 were retrospectively analyzed. Results: Of the 42 women, 41 were women and 1 was males, ranging in age from 16 to 63 (mean, 31.1) years. Tumor in the head of the pancreas in 10 cases, 3 cases of pancreatic neck, tail in 29 cases. The largest diameter of tumor 2 ~ 15 cm, an average of 6.3 cm. Twenty patients had no obvious symptoms at the time of treatment, only 21 patients had upper abdominal pain and discomfort, and 1 patient had severe abdominal pain accompanied by fever due to rupture of the tumor. Ultrasonography found that the pancreas hypoechoic or equal echo or cystic solid mixed masses, CT examination showed multiple round pancreas pancreatic cystic tumor, enhance the solid part to varying degrees of enhancement. Patients underwent surgical resection, confirmed by pathology of solid pseudopapillary pancreatic tumor. Among them, 2 patients had pancreaticoduodenectomy who retained pylorus, 2 had pancreatoduodenectomy with duodenum retained, 10 had pancreatectomy resection with retained spleen, and 13 had pancreaticotomosomic excision , 14 cases of local excision, 1 case of palliative resection. Forty patients were followed up from 6 months to 11 years with an average of 49 months, all of whom survived without any distant metastasis. One case of tumor local excision 8 years local recurrence by reoperation local excision, so far 41 months did not find tumor recurrence. CONCLUSIONS: In young women with solid mixed pancreatic neoplasm, solid pseudopapillary tumors of the pancreas should be highly suspected. The tumor is of low grade and can be operated for as long as possible under the condition of complete excision survive.