Cho Yu Jeong, Namgoong Jung-Man, Kim Dae Yeon, Kim Seong Chul, Kwon Hyun Hee
Department of Pediatric Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, South Korea.
Front Pediatr. 2019 Apr 3;7:125. doi: 10.3389/fped.2019.00125. eCollection 2019.
Solid pseudopapillary neoplasms (SPNs) are rare, low-grade, malignant neoplasms that can occur in pediatric patients. Although complete resection of the tumor is the principle treatment, SPN enucleation (EN) has been reported to be effective in children. This study aimed to examine the feasibility and safety of EN by comparing it with conventional pancreatectomy (CP), and to present the indications for its use in pediatric patients. We retrospectively reviewed the medical records of 66 patients who underwent surgery for SPN at our institution from October 1992 to April 2018. Surgical methods, postoperative complications, hospital stay, and recurrence were compared. Of the 66 patients, 15 (22.7%) were treated with EN and 51 (77.3%) were treated with CP. The mean duration of EN operation was 262 min (±145 min) and of CP was 345 min (±195 min). There was no statistically significant difference between the two methods ( = 0.13). To objectively compare the mass size between patients, we introduced a tumor size/intraperitoneal width ratio, which also revealed no significant difference between the 2 surgery groups ( = 0.21). The EN group had one case of recurrence at the resection site. The complications observed were fluid collection, splenic infarctions, hematomas, pancreatic fistulas, portal vein thromboses, and chylous drainage, among which pancreatic fistulas were the most frequent followed by moderate-severe fistulas in the EN group ( < 0.001). The mean postoperative fasting time (EN 17.0 ± 8.7 days vs. CP 5.1 ± 3.3 days, < 0.001) and mean hospital stay (EN 23.4 ± 10.0 days vs. CP 13.2 ± 6.5 days, = 0.002) showed statistically significant differences. Compared with CP treatment, EN of SPNs in children has the disadvantages of prolonged fasting times and hospital stays to recover from moderate pancreatic fistulas. However, if appropriate indications are applied, EN can be considered a safe and effective surgical procedure for children.
实性假乳头状肿瘤（SPNs）是一种罕见的低度恶性肿瘤，可发生于儿童患者。尽管肿瘤完整切除是主要治疗原则，但据报道，SPN摘除术（EN）对儿童有效。本研究旨在通过将EN与传统胰腺切除术（CP）进行比较，探讨EN的可行性和安全性，并提出其在儿童患者中的应用指征。我们回顾性分析了1992年10月至2018年4月在我院接受SPN手术的66例患者的病历。比较了手术方法、术后并发症、住院时间和复发情况。66例患者中，15例（22.7%）接受了EN治疗，51例（77.3%）接受了CP治疗。EN手术的平均持续时间为262分钟（±145分钟），CP手术为345分钟（±195分钟）。两种方法之间无统计学显著差异（P = 0.13）。为客观比较患者之间的肿块大小，我们引入了肿瘤大小/腹腔内宽度比，结果显示两个手术组之间也无显著差异（P = 0.21）。EN组有1例在切除部位复发。观察到的并发症有积液、脾梗死、血肿、胰瘘、门静脉血栓形成和乳糜引流，其中胰瘘最为常见，EN组中重度瘘更为常见（P < 0.001）。术后平均禁食时间（EN为17.0±8.7天，CP为5.1±3.3天，P < 0.001）和平均住院时间（EN为23.4±10.0天，CP为13.2±6.5天，P = 0.002）显示出统计学显著差异。与CP治疗相比，儿童SPN的EN治疗有禁食时间和住院时间延长以从中度胰瘘恢复的缺点。然而，如果应用适当的指征，EN可被认为是一种对儿童安全有效的手术方法。
