【摘要】：目的探討胰腺實性假乳頭狀瘤(Solid Pseudopapillary Tumor,SPT)的臨床特點、影像學(xué)特點、實驗室檢查、病理學(xué)特點、治療方法和預(yù)后情況。方法對鄭州大學(xué)第一附屬醫(yī)院肝膽胰外科于2010年2月到2017年1月收治的32例SPT患者的臨床資料進行回顧性分析并隨訪,診斷均經(jīng)過術(shù)前穿刺、術(shù)中病理或術(shù)后病理結(jié)果證實,分析總結(jié)其臨床特點、影像學(xué)特點、病理及免疫組化特點、治療方法及預(yù)后情況。結(jié)果1.32例患者中男性4例,女性28例,男女比為1:7,女性患者平均年齡29.0±14.16歲,男性患者平均年齡31±13.64歲,女性患者平均年齡低于男性患者平均年齡。2.腫瘤大多數(shù)為單發(fā),邊界清,最小直徑1.5cm,最大直徑12.1cm,平均直徑5.4cm,多為囊實性。腫瘤可位于胰腺的頭部、頸部、體部和尾部,大多位于胰腺尾部。3.患者臨床表現(xiàn)大多無明顯癥狀,而有癥狀者主要表現(xiàn)為腹脹,腹痛和腹部包塊。4.術(shù)前實驗室檢查各腫瘤標記物幾乎均為陰性,故腫瘤標記物對SPT診斷無特異性。5.影像學(xué)檢查32例均行CT檢查,27例報告為SPT,準確率為84.4%(27/32),12例行MRI檢查,9例報告為SPT,準確率75%(9/12)。CT引導(dǎo)下細針穿刺活檢6例,術(shù)中快速冰凍4例,準確率100%。6.免疫組化中:AAT陽性率100%,CD56陽性率100%,Vimentin陽性率96%,β-catenin陽性率95%,CD10陽性率90%,Cg A陰性率88%,Ki-67≤5%陽性率87%,PR陽性率83%,Syn陽性率78%,CK陽性率74%,CD99陽性率71%,CD34陽性率57%,NSE陽性率50%,可用于診斷SPT。7.32例SPT患者中30例行手術(shù)治療,胰腺腫瘤切除術(shù)7例,胰體尾切除術(shù)3例,胰體尾(胰尾)+脾臟切除術(shù)15例,胰十二指腸切除術(shù)4例,剖腹探查術(shù)1例。1例發(fā)現(xiàn)時已有肝臟多發(fā)轉(zhuǎn)移,無法手術(shù),1例為腫瘤自發(fā)性破裂出血,行抗休克及止血等保守治療。術(shù)后并發(fā)癥主要為胰腺假性囊腫和胰瘺,平均住院天數(shù)22.5天。術(shù)后1例失訪,其余31例隨訪6個月至84個月,無死亡病例,無腫瘤新發(fā)及轉(zhuǎn)移。結(jié)論1.SPT為好發(fā)于年輕女性的少見的胰腺低度惡性腫瘤,雖低度惡性,但仍有遠處臟器轉(zhuǎn)移及周圍器官侵犯。2.SPT無特異的臨床表現(xiàn),主要癥狀為腹痛、腹部包塊。3.腫瘤標記物對術(shù)前診斷無特異性。4.CT及MRI對SPT術(shù)前診斷有重要意義,并能對腫瘤的大小、數(shù)量、部位、周圍有無侵犯提供詳細的信息,術(shù)前穿刺病理或術(shù)中病理結(jié)合影像學(xué)檢查可指導(dǎo)手術(shù)方式的選擇。5.治療方法主要是手術(shù)治療,手術(shù)完整切除腫瘤后患者預(yù)后好,生存期長。
[Abstract]:Objective to investigate the clinical features, imaging features, laboratory examination, pathological features, treatment and prognosis of solid pseudopapidoma of pancreas (Solid Pseudopapillary Tumor,SPT). Methods the clinical data of 32 patients with SPT treated in the Department of Hepatobiliary and Pancreatic surgery, the first affiliated Hospital of Zhengzhou University from February 2010 to January 2017 were analyzed and followed up. The diagnosis was confirmed by preoperative puncture, intraoperative pathology or postoperative pathological results. The clinical features, imaging features, pathological and immunohistochemical features, treatment methods and prognosis were analyzed and summarized. Results 1. Among 32 patients, there were 4 males and 28 females, the ratio of male to female was 1 鈮，

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