摘要
目的总结胰腺实性假乳头状瘤(pSPN)的临床特点。方法回顾性分析2007年3月至2022年8月于浙江大学医学院附属第一医院接受手术治疗的253例pSPN患者的临床资料和随访情况。比较分析术前超声、磁共振成像(MRI)、计算机断层扫描(CT)和穿刺活检术诊断准确率,采用Kaplan-Meier方法计算无病生存率。比较pSPN的临床和病理特征的性别差异。按照初次术后是否发生复发转移将pSPN分为复发转移组(3例)和无病生存组(250例),采用单因素分析探究性别、年龄、已婚、有临床症状、有饮酒或吸烟史、术前进行穿刺活检术、肿瘤位置和最大径、手术方式(开放性手术、微创手术)、手术类型(保留实质手术、传统手术)、病理特征(肿瘤细胞异型性、侵犯邻近器官、脉管癌栓、胰腺周围组织侵犯、神经侵犯、包膜侵犯、胰腺内浸润性生长)是否为pSPN复发转移的预测因素。统计学方法采用两独立样本t检验、卡方检验、Fisher确切概率法。结果253例pSPN患者中,男49例(19.4%),女204例(80.6%)。MRI、CT诊断准确率均高于超声[73.4%(124/169)、64.0%(146/228)比33.3%(78/234)],MRI诊断准确率高于CT,差异均有统计学意义(χ^(2)=62.93、43.58、3.89,P<0.001、<0.001、=0.049)。联合免疫组织化学检查的穿刺活检术的诊断准确率高于未联合免疫组织化学检查[100.0%(23/23)比8/13],差异有统计学意义(Fisher确切概率法,P=0.003)。8例患者失访,余245例患者均存活,5、10年无病生存率分别为99.2%、97.2%。男性pSPN患者确诊年龄大于女性患者,肿瘤最大径小于女性患者[(40.0±13.2)岁比(32.6±11.9)岁,(3.88±2.05)cm比(4.87±3.05)cm],差异均有统计学意义(t=3.83、-2.15,P<0.001、=0.032)。单因素分析结果显示,脉管癌栓与pSPN复发转移显著相关(Fisher确切概率法,P=0.012),其余因素均与pSPN复发转移不相关(均P>0.05)。结论CT、MRI和穿刺活检术是较可靠的pSPN术前诊断手段。p
ObjectiveTo summarize the clinical characteristics of pancreatic solid pseudopapillary neoplasm(pSPN).MethodsFrom March 2007 to August 2022,at the First Affiliated Hospital of Zhejiang University School of Medicine,the clinical data and follow-up results of 253 patients with pSPN and underwent surgical treatment were retrospectively analyzed.The diagnostic accuracy of preoperative ultrasound,magnetic resonance imaging(MRI),computed tomography(CT)and puncture biopsy of aspiration were compared and analyzed.Kaplan-Meier method was performed to calculate disease-free survival rate.The gender differences in the clinical and pathological features of pSPN were compared.According to whether recurrence and metastasis occurred after the primary operation,the patients with pSPN were divided into recurrence and metastasis group(n=3)and disease-free survival group(n=250).Univariate analysis was used to analyze whether gender,age,married status,with clinical symptoms,history of alcohol drinking or smoking,puncture biopsy of aspiration before operation,location and maximum diameter of tumor,surgical method(open surgery,minimally invasive surgery),type of surgery(parenchymal preservation surgery,conventional surgery),and pathological features(cellular atypia,invasion of adjacent organs,lymphovascular invasion,peripancreatic fat invasion,perineural invasion,capsular invasion and pancreatic parenchyma invasion)were predictive factors of recurrence and metastasis of pSPN.Two independent sample t test,chi-square test and Fisher′s exact test were used for statistical analysis.ResultsAmong 253 patients with pSPN,49(19.4%)were males and 204(80.6%)were females.The diagnostic accuracy of MRI and CT were both higher than that of ultrasound(73.4%(124/169),64.0%(146/228)vs.33.3%(78/234)),and the diagnostic accuracy of MRI was higher than that of CT,and the differences were statistically significant(χ^(2)=62.93,43.58 and 3.89,P<0.001,<0.001 and=0.049).The diagnostic accuracy of puncture biopsy of aspiration combined with immunochemistry
作者
邓豪
莫平凡
黄怡婷
许国强
Deng Hao;Mo Pingfan;Huang Yiting;Xu Guoqiang(Department of Gastroenterology,the First Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310003,China)
出处
《中华消化杂志》
CAS
CSCD
北大核心
2023年第7期465-471,共7页
Chinese Journal of Digestion
关键词
胰腺实性假乳头状瘤
临床特点
性别差异
预后
Pancreatic solid pseudopapillary neoplasm
Clinical characteristics
Gender difference
Prognosis
