目的 探讨胰腺囊性肿瘤的诊断及外科治疗方法。方法 对我院2003年4月至2012年4月期间收治的19例胰腺囊性肿瘤患者的临床资料进行回顾性分析。结果 本组19例患者中浆液性囊腺瘤8例，黏液性囊腺瘤5例，导管内乳头状黏液瘤4例，实性假乳头状瘤1例，囊腺癌1例。行B超或CT发现胰腺占位病变。位于胰头部5例，胰体部8例，胰尾部6例。行肿瘤摘除术4例，保留脾脏的胰体尾切除术5例，胰体尾＋脾脏切除手术3例，胰十二指肠切除术6例，1例囊腺癌患者因肝脏转移伴腹腔广泛转移、侵犯大血管而肿瘤不能切除仅行胃空肠、胆肠吻合。术后发生胰瘘2例，腹腔感染1例，经保守治疗后康复出院。无围手术期死亡病例。19例患者均进行了随访，随访时间6～80个月，平均45.2个月。1例囊腺癌合并肝脏转移患者于术后7个月死亡，其余良性肿瘤患者均未见复发，最长已存活5年。结论 胰腺囊性肿瘤主要靠影像学检查发现，手术切除是理想的治疗方法，选择合适的术式有助于避免术后并发症的发生和改善预后。
ObjectiveTo review the current clinical application of Beger procedure and Frey procedure for benign disease or low-grade malignant potential lesion of pancreas. MethodsRelevant literatures about current advance of clinical application of Beger procedure and Frey procedure published recently of domestic and abroad were collected and reviewed. ResultsWith the concept of organ-preserving operations was adopted in recent years, Beger procedure and Frey procedure were applied generally. Beger procedure and Frey procedure were associated with tolerable perioperative risk, postoperative complications, and good outcomes in the aspects of preservation of function and curability in these lesions compared to conventional pancreatectomy, with preservation of the physiological food passage, thus patients gained weight faster, had less pain, and demonstrated better exocrine and endocrine pancreatic function postoperatively and an improvement in the quality of life. Both procedures had reached an international position as a standard operation for the treatment of benign disease or low-grade malignant potential lesion of pancreas. But after long-term following-up early advantages were no longer present. ConclusionsBeger procedure and Frey procedure are safe and effective in providing good outcomes in the aspects of preservation of function and curability in benign disease or low-grade malignant potential lesion of pancreas. Organ-preserving pancreatectomy could become a new organ-preserving standard operation.
ObjectiveTo investigate the diagnosis and treatment of pancreatic cystic neoplasm. MethodsThe clinical data of 40 cases of pancreatic cystic neoplasm from October 2001 to October 2013 in our hospital were retrospec-tively analyzed. ResultsPatients with pancreatic cystic neoplasm had no specific clinical feature. Ultrasonography and computed tomography displayed a cystic tumor in 57.5%(23/40) and 72.5%(29/40) of all patients, respectively, but could not distinguish the histological types. All of the patients had been operated, among them 2 cases were misdia-gnosed as pseudocysts and internal drainage; another 38 patients were undergoing the distal pancreatectomy. Pathologic examination results after operation showed 23 cases of serous cystadenoma, 9 cases of mucinous cystadenoma, 3 cases of intraductal papillary mucinous adenoma, and 5 cases of mutinous cystadenocarcinoma. Thirty five patients were followed-up. The followed-up time range from 2 months to 8 years, verage(74.2±12.8) months. Among the 3 patients with mucinous cystadenocarcinoma, 1 patient alived with no evidence of recurrence, the other 2 patients died of tumor invasion and metastasis in 4 months and 7months after operation. The others were still alive now with no evidence of recurrence. ConclusionSurgical resection is the most effective treatment for pancreatic cystic tumor, even if the patients with no any symptoms.
ObjectiveTo investigate diagnosis and treatment of rupture of pancreatic cystic disease. MethodThe clinical data of 20 patients who were diagnosed as pancreatic cystic disease combined with rupture in the First Affiliated Hospital of Harbin Medical University from June 2011 to December 2015 were analyzed retrospectively. Results① For the 5 patients with pancreatic cystic tumor, 3 patients of them received distal pancreatectomy and 2 patients of them received Whipple procedure. For the 15 patients with pancreatic pseudocyst, 2 patients received ultrasound-guided cyst puncture and drainage, 2 patients received endoscopic retrograde pancreatic drainage (ERPD), 2 patients received ERPD plus ultrasound-guided cyst puncture and drainage, 1 patient received pancreatic external drainage, 3 patients received pancreatic cyst-gastric anastomosis, 5 patients received pancreatic cyst-jejunal Roux-en-Y anastomosis. ② Pancreatic fistula occurred in 3 patients (Grade A 2 cases, Grade B 1 case), delayed gastric emptying was found in 1 patient, peritoneal effusion occurred in 1 patient. ③ Eighteen of them were followed up from 3 to 60 months with an average 25.6 months, 2 patients recurred and non-surgical treatments were taken. ConclusionsHow to correctly identify pancreatic cystic tumor with pancreatic pseudocyst is premise of treatment. Pancreatic cystic disease combined with rupture requires urgent therapy. Based on clinical manifestations, optimal selection might achieve a better prognosis.
This study aims to predict expression of Ki67 molecular marker in pancreatic cystic neoplasm using radiomics. We firstly manually segmented tumor area in multi-detector computed tomography (MDCT) images. Then 409 high-throughput features were automatically extracted and the least absolute shrinkage selection operator (LASSO) regression model was used for feature selection. After 200 bootstrapping repetitions of LASSO, 20 most frequently selected features made up the optimal feature set. Then 200 bootstrapping repetitions of support vector machine (SVM) classifier with 10-fold cross-validation were used to avoid overfitting and accurately predict the Ki67 expression. The highest prediction accuracy could achieve 85.29% and the highest area under the receiver operating characteristic curve (AUC) was 91.54% with a sensitivity (SENS) of 81.88% and a specificity (SPEC) of 86.75%. According to the results of experiment, the feasibility of predicting expression of Ki67 in pancreatic cystic neoplasm based on radiomics was verified.
ObjectiveTo investigate the guiding value of preoperative imaging and intraoperative rapid pathology in the diagnosis and treatment of pancreatic cystic neoplasm (PCN).MethodsThe clinical data of 205 patients with PCN diagnosed by pathology from July 14, 2003 to July 31, 2018 were analyzed retrospectively. The precise and fuzzy diagnostic rate and misdiagnosis rate of PCN by preoperative imaging and intraoperative rapid pathology were analyzed.ResultsThe most commonly used preoperative imaging methods were ultrasound and CT, in 146 cases (82.95%) and 141 cases (80.11%), respectively. There were 54 cases (30.68%) with MRI. Of them, 47 cases were examined by single examination, 129 cases received combined examination, of which 123 cases (95.35%) were examined by ultrasound combined with CT. The precise and fuzzy diagnostic rate of PCN by ultrasound, CT, and MRI were 81.51% (119/146), 81.56% (115/141), and 87.04% (47/54), respectively. Comparison of ultrasound with CT and MRI showed statistical significance (χ2=47.747, P<0.001; χ2=11.873, P=0.018), but no significant difference was observed between CT and MRI (χ2=5.012, P>0.05). In 27 cases of false diagnosis by ultrasound, no obvious abnormality was found in 14 cases (51.85%), followed by misdiagnosis as pancreatic pseudocyst (11 cases, 40.74%). Of the 26 cases misdiagnosed as pancreatic cancer by CT, 57.69% (15 cases) were misdiagnosed as pancreatic cancer; 7 cases were misdiagnosed by MRI, 42.86% (3 cases) of patients were misdiagnosed as pancreatic cancer and pancreatic pseudocyst. Thirty-one cases were misdiagnosed by intraoperative rapid pathology, and most of them misdiagnosed as pancreatic pseudocyst (10 cases, 32.26%). The next was SPN misdiagnosed as pancreatic neuroendocrine tumor (7 cases, 22.58%). The precise and fuzzy diagnostic rates of PCN were 81.58% (124/152), 86.84% (132/152), and 97.37% (148/152) in preoperative imaging, intraoperative rapid pathology, and preoperative imaging combined with intraoperative rapid pathology, while the misdiagnostic rates were 18.42% (28/152), 13.16% (20/152), and 2.63% (4/152), respectively.ConclusionsIn preoperative imaging and intraoperative rapid pathological examination, it is possible that ultrasound could not find PCN lesions. CT and MRI are most likely to be misdiagnosed as pancreatic cancer. Intraoperative rapid pathological examination misdiagnosed as pancreatic pseudocyst is most common. Perfect preoperative imaging and rapid intraoperative pathology can improve the correct diagnosis rate of PCN and avoid unreasonable surgical intervention measures.
ObjectiveTo summarize the experience of diagnosis and treatment of pancreatic cystic neoplasms (PCN).MethodThe general information, imaging findings, preoperative blood biochemical indexes, tumor markers, operation related data, postoperative complications, and pathological results of patients with PCN confirmed by pathological examination in Affiliated Hospital of Xuzhou Medical University from January 1, 2014 to December 31, 2019 were retrospectively analyzed.ResultsAmong the 158 patients who underwent surgical resection, the male to female ratio was 1∶1.6, and the median age was 56.2 years (range 26 to 82 years). Serous cystadenoma (SCN) was the most common, accounting for 34.2% (n=54), followed by mucinous cystadenoma (MCN) and intraductal papillary mucinous neoplasm (IPMN), accounting for 26.6% (n=42) and 20.2% (n=32). The proportion of solid pseudopapillary tumor (SPT) was the smallest, which was 19.0% (n=30). The PCN malignant rate was 19.0% (n=30), with the highest malignant rate being IPMN (43.8%, n=14), and the lowest being SCN (3.7%, n=2). Patients with PCN malignant group had significantly higher serum CA19-9, CEA, CA125, and neutrophil/lymphocyte ratio (NLR) than those in the benign group（all P<0.05）. The preoperative diagnosis of PCN was ambiguous, and the rate of misdiagnosis was high. The correct diagnosis rate of accurate preoperative specific classification was only 31.6% (n=50), and the lowest SCN (14.8%, n=8). High CA19-9, high NLR value, tumor location in the head/neck of pancreas and enhanced solid component were independent predictors of malignant PCN (P<0.05).ConclusionImproving the preoperative diagnosis ability of PCN and accurately determining the PCN classification before operation are helpful for the standardized treatment of PCN.
Objective To summarize the research progress in the diagnosis and treatment of pancreatic cystic neoplasms (PCNs). Method The guidelines and literatures related to the diagnosis and treatment of PCNs were collected and reviewed. Results At present, there was still no clear method to distinguish the types of PCNs and their benign and malignant, and there was still a dispute between domestic and foreign guidelines on the diagnosis and treatment of PCNs. Conclusion Clinical researchers still need to carry out more research, provide higher quality evidence, resolve the disputes existing in different guidelines, standardize the diagnosis and treatment process of PCNs, thus, PCNs can be identified early, diagnosed accurately and intervened in time.