本文選題：漿液性囊腺瘤 + 胰腺��； 參考：《浙江大學(xué)》2017年碩士論文

【摘要】：目的:胰腺漿液性囊腺瘤(serous cystic neoplasms,SCNs)術(shù)前診斷仍然是臨床工作中的難題,本文旨在分析其臨床特點、影像學(xué)檢查、治療方法和預(yù)后情況,從而提高術(shù)前診斷,減少不必要的手術(shù)治療,為本病的治療提供指導(dǎo)。方法:收集浙江大學(xué)醫(yī)學(xué)院附屬第一醫(yī)院2005年1月至2016年12月經(jīng)手術(shù)切除和病理證實確診為胰腺漿液性囊腺瘤的77例患者的臨床資料,回顧性分析住院病史、臨床表現(xiàn)(癥狀和體征)、實驗室檢查、影像學(xué)結(jié)果、術(shù)前診斷、治療(術(shù)式、并發(fā)癥等)、病理結(jié)果、復(fù)查隨訪等資料并查閱相關(guān)文獻進行總結(jié)。結(jié)果:77例病理診斷為漿液性囊腺瘤的患者中,女性64例,男性13例,中位年齡53歲(22-82歲)。33例合并臨床癥狀如腹痛、腰背痛、惡心嘔吐、黃疸等,腹痛為最常見癥狀,剩余患者因體檢發(fā)現(xiàn),病程最短2天,最長12年。胰體尾部腫瘤平均大小大于胰頸部(P=0.008)。2例CA125升高,5例CA199升高,8例鐵蛋白升高。76例行B超檢查,病灶檢出率為96.05%,大致診斷率為38.16%,無明確診斷;69例行CT檢查,病灶檢出率為98.55%,大致診斷率為52.17%,確診率為5.80%;37例行MRI檢查,病灶檢出率為97.30%,大致診斷率為59.46%,確診率為5.4%,23例行MRCP檢查,病灶檢出率為86.95%,大致診斷率為21.74%,確診率為4.35%;14例行EUS檢查,病灶檢出率為100%,大致診斷率為57.14%,確診率為35.71%。EUS和MRI在囊腺瘤診斷率方面高于B超(p0.05)。B超聯(lián)合CT檢查大致診斷率為98.53%,CT聯(lián)合EUS的大致診斷率為100%,確診率為62.5%,CT聯(lián)合MRI大致診斷率為96.55%,確診率為10.34%,MRI聯(lián)合EUS大致診斷率85.5%,確診率50%。19例行胰十二指腸切除術(shù),12例行胰腺中段切除術(shù),19例行胰體尾聯(lián)合脾臟切除術(shù),19例行保留脾臟胰體尾切除術(shù),8例行胰腺腫塊剜除術(shù)。18例患者發(fā)生胰漏,胰漏與手術(shù)方式無關(guān)。結(jié)合手術(shù)記錄及術(shù)后病理顯示腫瘤19例位于胰頭,42例位于胰體尾,16例位于胰頸。根據(jù)病理以及結(jié)合影像學(xué),56例為微囊型,9例為寡囊型,9例為混合型,3例為實性。63例患者獲得隨訪,中位隨訪時間39.99月,4例患者因其他疾病死亡,7例術(shù)后新發(fā)糖尿病,所有患者均無復(fù)發(fā)或癌變。結(jié)論:1.胰腺漿液性囊腺瘤起病隱匿,多數(shù)無特異性臨床表現(xiàn)、腫瘤標志物升高,無胰腺炎病史和黃疸等浸潤表現(xiàn),好發(fā)于中年女性。2.B超、CT、MRI和EUS均有較高的病灶檢出率,CT和MRI表現(xiàn)有一定的特征性,有較高的大致診斷率,EUS有較高的診斷率。B超聯(lián)合CT后有較高的大致診斷率,CT或MR[聯(lián)合EUS.可顯著提高大致診斷率和確診率,建議采取B超篩查病灶,通過CT/MRI進一步診斷。3.漿液性囊腺瘤好發(fā)于胰體尾部,病理分型以微囊型為主,是一種良性腫瘤,術(shù)后恢復(fù)良好,極少復(fù)發(fā)或惡變。4.在治療上,認為有癥狀以及術(shù)前無法排除惡性可能的病人需要積極手術(shù)。根據(jù)不同特征選擇合理的手術(shù)方式,完整切除腫瘤的同時保留更多的正常組織和器官,從而減少術(shù)后并發(fā)癥提高生活質(zhì)量。
[Abstract]:Objective: preoperative diagnosis of pancreatic serous cystadenoma (serous cystic neoplasms) is still a difficult problem in clinical work. The purpose of this article is to analyze its clinical characteristics, imaging examination, treatment methods and prognosis, so as to improve the preoperative diagnosis. Reduce unnecessary surgical treatment and provide guidance for the treatment of this disease. Methods: the clinical data of 77 patients with pancreatic serous cystadenoma confirmed by surgery and pathology from January 2005 to December 2016 in the first affiliated Hospital of Zhejiang University Medical College were collected and analyzed retrospectively. Clinical manifestations (symptoms and signs), laboratory examination, imaging results, preoperative diagnosis, treatment (operation, complications, etc.), pathological findings, follow-up and other data were reviewed and reviewed. Results among 77 cases of serous cystadenoma diagnosed by pathology, 64 cases were female, 13 cases were male, the median age was 53 years (22-82 years) .33 cases with clinical symptoms such as abdominal pain, low back pain, nausea and vomiting, jaundice, etc., abdominal pain was the most common symptom. The remaining patients were found to have a shortest course of disease of 2 days and a maximum of 12 years due to physical examination. The mean size of tumors in the body and tail of pancreas was larger than that in the neck of pancreas (P < 0.008). The mean size of CA125 was larger than that in the neck of pancreas (P < 0.008). 5 cases were elevated in CA199 and 8 cases were elevated ferritin. 76 cases were examined by B-ultrasound. The detection rate of lesions was 96.05 and the approximate diagnostic rate was 38.16. No definite diagnosis was made in 69 cases of CT. The detection rate of lesions was 98.55 and the approximate diagnostic rate was 52.17. The diagnostic rate was 5.80 and 37 cases MRI examination. The detection rate of lesions was 97.30. The approximate diagnostic rate was 59.46. The diagnostic rate was 5.445%. The diagnostic rate was 86.955.The overall diagnostic rate was 21.74%, and the diagnostic rate was 4.3510% in 14 cases of EUS examination. The detection rate of lesions was 100 and the approximate diagnostic rate was 57.14. The diagnostic rate of cystadenoma was 35.71. EUS and MRI were higher than that of B-ultrasound (p0.05). The approximate diagnostic rate of CT combined with EUS was 98.533.The diagnostic rate of CT combined with EUS was 100, and the diagnostic rate of CT combined with MRI was 62.5%. The diagnostic rate of MRI combined with EUS was 85. 5%. The diagnostic rate was 50. 19 cases with pancreatoduodenectomy and 12 cases with middle pancreatectomy and 19 cases with pancreatectomy combined with splenectomy. 19 cases with splenic body and tail resection and 19 cases with splenic body and tail excision. Pancreatic leakage occurred in 18 patients undergoing enucleation of pancreatic masses. Pancreatic leakage has nothing to do with the operative method. Combined with surgical records and postoperative pathology, 19 cases were located in the head of pancreas, 42 cases were located in the body and tail of the pancreas, 16 cases were located in the neck of the pancreas. According to the pathological and imaging findings of 56 cases of microcapsule type 9 cases of oligocapsule type 9 cases of mixed type 3 cases of solid. 63 cases were followed up. The median follow-up time was 39. 9 months and 4 cases died of other diseases. No recurrence or canceration was found in all patients. Conclusion 1. Most of the pancreatic serous cystadenomas had no specific clinical manifestations, increased tumor markers, no history of pancreatitis and jaundice, etc. The detection rate of CT and EUS in CT and EUS were higher than those in middle aged women. The CT and MRI findings were characteristic, and the diagnostic rate of EUS was higher than that of EUS. The diagnostic rate of CT or Mr [combined with EUSUS] was higher than that of B-ultrasonography combined with CT. It is suggested that B-mode ultrasound should be used to screen the lesions and further diagnose .3by CT / MRI. Serous cystadenoma usually occurs in the tail of the pancreatic body. The pathological type is mainly microencapsulated. It is a benign tumor with good recovery after operation and few recurrence or malignancy. 4. In treatment, patients who are symptomatic and who cannot rule out the possibility of malignancy need active surgery. According to different characteristics, reasonable operation methods were selected, and more normal tissues and organs were retained while tumor was removed completely, so as to reduce postoperative complications and improve quality of life.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.9

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