Diagnosis And Treatment Of Pancreatic Cystic Neoplasms

Objective:Through the retrospective analysis and the related literature of the diagnosis and treatment of pancreatic cystic neoplasms in Jilin University 2nd Hospital and Jilin University Sino-Japanese Friendship Hospital,the surgical indications and surgical methods of pancreatic cystic neoplasms are summarized by using appropriate statistical analysis methods,which provide a basis for the reasonable diagnosis and treatment of pancreatic cystic neoplasms.Methods:Retrospective analysis of Jilin University 2nd Hospital in the past 4 years(Jan.2014-Nov.2017),Jilin University Sino-Japanese Friendship Hospital in the past 5 years(Jan.2012-Dec.2016)a total of 85 patients with pancreatic cystic neoplasms medical records and postoperative follow-up survey,According to general information,imaging findings,tumor markers,surgery and complications,pathological information,prognosis and follow-up to drawing a table,the main research is on the effects of the patients prognosis of tumor size,tumor markers,surgical methods and complications by using appropriate statistical analysis methods.Results:85 cases of patients with pancreatic cystic neoplasms,including 32 cases of Solid Pseudopapillary Neoplasm(SPN),21 cases of Intraductal Papillary Mucinous Neoplasm(IPMN),23 cases of Mucinous Cystic Neoplasm(MCN),and 9 cases of Serous Cystic Neoplasm(SCN).There were 25 male patients and 60 female patients,and the ratio of male to female is 1:2.5.Most of the patients were found by physical examination or abdominal discomfort,especially post-meal abdominal discomfort.After the related examinations were completed,there were 12 cases of abnormal CA-199,including 4 cases of Mucinous Cystic Neoplasm,4 cases of Intraductal Papillary Mucinous Neoplasm,3 cases of Solid Pseudopapillary Neoplasm,1 case of Serous Cystic Neoplasm,and remaining laboratory tests are normal;In the imaging examinations,all patients underwent abdominal ultrasonography,the ultrasound,CT,MRI detection rate are 91.56%,93.75%,98.14%.51 cases of the diameter of the tumor are≥3cm,and 34 cases are<3cm.The location of the tumor was located in pancreatic head in 16 cases,5 cases of pancreatic neck,20 cases of pancreatic body,36 cases of pancreatic tail,and 8 cases of uncinate.There were 8 cases of wall nodules,of which 5 cases were strenthen(4 cases of MCN,including 2 cases of postoperative pathology are malignant;1 case of SPT).There were 72 cases of single capsule and 13 cases of polycystic.There were 41 cases of wall reinforcement and 44 cases of no enhancement.There were 63 cases with separation and 22 cases without separation.There were 6 cases of calcification,79 cases of no calcification,3 cases of calcification center,and 3 cases of margin.There were 52 cases of solid components in the capsule and 33 cases without solid components.There were 4 cases of shrivel pancreatic body and 81 cases of normal.There were 3 cases of pancreatitis and 82 cases of no pancreatitis.There were 12 cases communicating with the main pancreatic duct and 73 cases without communication.There were 20 cases of main pancreatic duct dilatation,including 12 cases of main pancreatic duct diameter of 4mm,3 cases of 6mm,1 case of 5mm,7mm,10 mm,15mm,23 mm,and 69 cases of non-expansion.All the 85 patients were surgeried.According to the preoperative status assessment,tumor location and doctor-patient communication results,16 cases of pancreaticoduodenectomy,22 cases of pancreatic body and splenectomy(including 4 cases under laparoscopy),22 cases of mass removal((including 5 cases under laparoscopy),11 cases of mid-pancreatic resection,11 cases of pancreatic body resection with spleen preservation(including 5 cases under laparoscopy),3 cases of laparotomy((including 1 case under laparoscopy).Intraoperative pancreaticojejunostomy was performed in 10 cases of mucosal-to-mucosal end-to-side anastomosis,20 cases of inlaid U-shaped suture,3 cases of pancreatic jejunal lateral anastomosis.The operation time was as short as 1 hour and the maximum was 12 hours,with an average of 3.7 hours.There were 19 patients with delayed gastric emptying after operation(including 16 cases of open surgery and 3 cases of laparoscopy),including 17 cases of grade A and 2 cases of grade B.There were 17 cases of pancreatic fistula(including 5 cases of mucosal-to-mucosal end-to-side anastomosis,11 cases of inlaid U-shaped suture,1 cases of pancreatic jejunal lateral anastomosis),including 14 cases of grade A,2 cases of grade B,and 1 case of grade C(combined with biliary fistula and died 12 days after surgery).The 5-year survival rate of 77 patients with benign tumors was 100%.The 1-,3-and 5-year survival rates of 8 patients with malignant tumors after radical surgery were 68.4%,51.7% and 30.4%,respectively.Conclusion:1,Postoperative pathologically confirmed CA-199 abnormal PCN patients(especially MCN,IPMN patients)had a higher probability of malignancy than patients with normal CA-199,but even if SPT,SCN patients had abnormal CA-199,most of the postoperative pathology was benign;Compared with SPT,patients with MCN and IPMN had a higher probability of abnormal CA-199 in patients with SCN,and the CA-199 value associated with malignancy was also higher.If the diameter of the tumor is less than 3cm,there is almost no risk of malignant transformation,and regular review can be performed.If necessary,surgery should be performed.If preoperative imaging suggests wall wall nodules,postoperative pathology suggests an increased probability of malignancy.2,Benign or low-grade malignant tumors located in the head of the pancreas can be resected by pancreaticoduodenectomy;tumors located in the neck and body of the pancreas and distal residual pancreatic tissue > 5 cm can be resected by mid-pancreatic resection.Although the risk of pancreatic fistula is high after operation,it has little effect on the normal endocrine and exocrine function of the pancreas,spleen-preserving pancreatic body-tail resection is feasible for tumors located at the tail of pancreas,and enucleation is feasible for tumors less than 2 cm in diameter away from the main pancreatic duct.3,Intraoperative pancreaticojejunostomy is not necessarily related to the occurrence of pancreatic fistula after operation,nor is laparoscopy necessarily related to the occurrence of postoperative complications.