Hosokawa Isamu, Shimizu Hiroaki, Ohtsuka Masayuki, Kato Atsushi, Yoshitomi Hideyuki, Furukawa Katsunori, Takayashiki Tsukasa, Ishihara Takeshi, Yokosuka Osamu, Miyazaki Masaru
Department of General Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
J Hepatobiliary Pancreat Sci. 2014 Aug;21(8):573-8. doi: 10.1002/jhbp.96. Epub 2014 Feb 17.
Preoperative diagnosis of solid pseudopapillary neoplasm of the pancreas (SPN) remains difficult and optimal surgical management for SPN has yet to be fully defined.
Retrospective analysis was undertaken of all 10 patients (six women, four men) who underwent surgery for SPN between 2001 and 2013.
Mean age was 26 years (range, 16-33 years) for women, and 50 years (range, 35-76 years) for men. Although large SPN showed typical imaging findings, small SPN (≤ 3.0 cm) appears as almost entirely solid tumors. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) was performed in six patients with atypical findings of SPN for differentiation from other pancreatic neoplasms. Definitive preoperative cytological diagnosis was achieved in all patients who underwent EUS-FNA. All 10 patients underwent surgical exploration. One patient with portal vein invasion and multiple lung metastases underwent pancreaticoduodenectomy combined with portal vein resection and reconstruction, followed by two pulmonary resections. This patient remains alive as of 34 months after the initial operation.
Endoscopic ultrasound-guided fine-needle aspiration is useful for definitive preoperative diagnosis of SPN. As long-term survival after surgical resection can be achieved even in patients with locally advanced and metastatic SPN, aggressive surgical resection should be performed.
胰腺实性假乳头状瘤（SPN）的术前诊断仍然困难，且SPN的最佳手术治疗方案尚未完全明确。
对2001年至2013年间接受SPN手术的所有10例患者（6例女性，4例男性）进行回顾性分析。
女性的平均年龄为26岁（范围16 - 33岁），男性为50岁（范围35 - 76岁）。尽管较大的SPN显示出典型的影像学表现，但较小的SPN（≤3.0 cm）几乎完全表现为实性肿瘤。对6例具有SPN非典型表现的患者进行了内镜超声引导下细针穿刺抽吸（EUS - FNA），以与其他胰腺肿瘤相鉴别。所有接受EUS - FNA的患者均获得了明确的术前细胞学诊断。所有10例患者均接受了手术探查。1例伴有门静脉侵犯和多发肺转移的患者接受了胰十二指肠切除术联合门静脉切除和重建，随后进行了两次肺切除术。该患者在初次手术后34个月仍然存活。
内镜超声引导下细针穿刺抽吸有助于SPN的术前明确诊断。即使是局部晚期和转移性SPN患者，手术切除后也可实现长期生存，因此应积极进行手术切除。
