Divarcı Emre, Dökümcü Zafer, Çetingül Nazan, Nart Deniz, Barbet Funda Yılmaz, Ergün Orkan, Çelik Ahmet
Department of Pediatric Surgery, Ege University School of Medicine, İzmir, Turkey.
Turk J Gastroenterol. 2017 May;28(3):214-218. doi: 10.5152/tjg.2017.16713. Epub 2017 Mar 23.
BACKGROUND/AIMS: Pancreatic solid pseudopapillary tumor (SPT) is a rare neoplasm in children. In this study, we aimed to present our surgical strategy based on minimal resection by enucleation or limited resection in localized pancreatic SPT.
We retrospectively analyzed the medical records of children who underwent surgical resection between October 2011 and September 2016.
Five female patients with a median age of 15 years (range, 14-17 years) were operated. Tumors were located in the pancreatic head (n=4) or tail (n=1). The median greatest tumor diameter was 9 cm (range, 5-13 cm). All the patients were investigated with MRI before the resection to demonstrate the relationship between the tumor and the main pancreatic duct. Patients underwent enucleation (n=4) for head localization or local distal resection without splenectomy (n=1) at the pancreatic tail. At postoperative follow-up, major pancreatic leakage was observed in two patients and endoscopically treated. Surgical margins were negative in all patients. The median follow-up period was 44 months (range, 2-59 months) and no local recurrence or distant metastasis was observed in the postoperative period.
An optimal surgical strategy is still controversial in pancreatic SPT in children. Radical resections such as pancreaticoduodenoctomy or distal pancreatectomy with splenectomy result in loss of pancreatic tissue for endocrine and exocrine functions. Minimal resections such as enucleation or limited pancreatic resection with negative surgical margins should be performed in selected patients with no invasion to the main pancreatic duct or adjacent organs.
背景/目的：胰腺实性假乳头状瘤（SPT）在儿童中是一种罕见的肿瘤。在本研究中，我们旨在介绍基于局部胰腺SPT行剜除术或有限切除术的最小化切除的手术策略。
我们回顾性分析了2011年10月至2016年9月期间接受手术切除的儿童的病历。
5例女性患者接受了手术，中位年龄为15岁（范围14 - 17岁）。肿瘤位于胰头（n = 4）或胰尾（n = 1）。肿瘤最大直径的中位数为9 cm（范围5 - 13 cm）。所有患者在切除术前均接受了MRI检查，以显示肿瘤与主胰管之间的关系。位于胰头的患者行剜除术（n = 4），位于胰尾的患者行局部远端切除术且未行脾切除术（n = 1）。术后随访发现，2例患者出现主要胰瘘并接受了内镜治疗。所有患者手术切缘均为阴性。中位随访期为44个月（范围2 - 59个月），术后未观察到局部复发或远处转移。
儿童胰腺SPT的最佳手术策略仍存在争议。诸如胰十二指肠切除术或带脾切除术的远端胰腺切除术等根治性切除术会导致胰腺内分泌和外分泌功能的组织丧失。对于未侵犯主胰管或相邻器官的特定患者，应行诸如剜除术或手术切缘阴性的有限胰腺切除术等最小化切除术。
