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目的总结胰腺实性-假乳头瘤(SPNP)临床特点,探讨其诊断及外科治疗方法。方法收集2008年9月至2012年6月第二军医大学长海医院胰腺外科收治的51例SPNP患者的病例资料,回顾性分析SPNP的临床病理特点及术式选择。根据肿瘤质地将患者分为实性组与囊实性组行病例-对照研究,分析肿瘤质地与侵袭性病理学表现的相关性。结果 51例患者中,45例为女性、6例为男性(7.5∶1);平均发病年龄为33.5±10.8(8~53)岁。临床表现以体检发现肿瘤(43.1%,22/51)、腹部疼痛(31.4%,16/51)及饱胀不适(13.7%,7/51)为主,其余包括腹部扪及包块(5.9%,3/51)和恶心呕吐(5.9%,3/51)。肿瘤直径为1~37.8cm,平均(6.3±5.8)cm;肿瘤位于胰头者12例(23.5%)、胰颈14例(27.5%)、胰体尾25例(49.0%)。所有患者均接受手术治疗,其中胰十二指肠切除术5例,保留幽门胰十二指肠切除术5例,胰腺节段切除术7例,脾+胰体尾切除术21例,保脾胰体尾切除术7例,肿瘤局部切除术6例。仅1例患者CA19-9水平轻度升高,其余患者肿瘤标记物均在正常范围内。病理检查结果证实15例有侵袭性病理学表现。病例-对照研究结果示实性肿瘤质地与胰腺实质浸润(P<0.01)、细胞异型性(P<0.01)及周围神经浸润(P<0.05)等高度侵袭性病理学表现相关。51例患者中6例失访,余45例随访时间26~74个月,随访期内患者均存活,且无明显复发或转移证据。结论 SPNP是一种少见的低度恶性肿瘤,手术治疗是目前主要的有效治疗方式,且较小术式更为适合,术后预后良好。实性肿瘤质地与胰腺实质浸润、细胞异型性及周围神经浸润等侵袭性病理学表现相关。
Objective To summarize the clinical features of pancreatic solid pseudopapillary neoplasm (SPNP) and to discuss its diagnosis and surgical treatment. Methods The data of 51 patients with SPNP admitted to Changhai Hospital of Second Military Medical University from September 2008 to June 2012 were retrospectively analyzed. The clinicopathological features and surgical options of SPNP were retrospectively analyzed. According to the tumor texture, the patients were divided into a case-control study of the solid group and the cystic solid group, and the correlation between tumor texture and invasive pathology was analyzed. Results Of 51 patients, 45 were female and 6 were male (7.5:1). The mean age of onset was 33.5 ± 10.8 (ranged from 8 to 53). Clinical manifestations showed that tumors (43.1%, 22/51), abdominal pain (31.4%, 16/51) and full discomfort (13.7%, 7/51) were found mainly on the physical examination. The rest included abdominal palpable mass (5.9% , 3/51) and nausea and vomiting (5.9%, 3/51). The diameter of tumor ranged from 1 to 37.8 cm, with an average of (6.3 ± 5.8) cm. Tumors were found in 12 cases of pancreatic head (23.5%), pancreatic neck in 14 cases (27.5%) and pancreatic body tail in 25 cases (49.0%). All patients underwent surgical treatment, of which pancreatoduodenectomy in 5 cases, retention of pylorus in pancreatoduodenectomy in 5 cases, pancreatic segmentectomy in 7 cases, splenic + pancreaticoduodenectomy in 21 cases, spleen Pancreaticobiliary resection in 7 cases, tumor resection in 6 cases. In only 1 patient, the level of CA19-9 was mildly elevated, while the remaining patients had tumor markers within the normal range. Pathological examination confirmed 15 cases of invasive pathology. Results of the case-control study showed that the texture of the solid tumor was correlated with high invasive pathological features such as pancreatic parenchymal invasion (P <0.01), cell atypia (P <0.01) and peripheral nerve infiltration (P <0.05) Of the 51 patients, 6 were lost to follow-up, and 45 were followed up for 26 to 74 months. All patients survived during the follow-up period with no evidence of recurrence or metastasis. Conclusion SPNP is a rare low-grade malignant tumor. Surgical treatment is the main effective treatment method at present. The smaller surgical procedure is more suitable and the postoperative prognosis is good. Solid tumor texture and pancreatic parenchymal infiltration, cell atypia and peripheral nerve invasion and other invasive pathological findings.