Talamini M A, Moesinger R, Yeo C J, Poulose B, Hruban R H, Cameron J L, Pitt H A
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Ann Surg. 1998 Jun;227(6):896-903. doi: 10.1097/00000658-199806000-00013.
The objective was to determine whether surgical enucleation of mucinous cystadenoma of the pancreas is a safe and adequate operation.
Mucinous cystadenomas of the pancreas are premalignant cystic lesions. Resection is the preferred treatment but often requires a pancreatoduodenectomy or a distal pancreatectomy with or without a splenectomy. Although these procedures can now be performed with a low mortality rate, substantial morbidity still occurs, especially in patients who have an otherwise normal pancreas.
Between January 1990 and June 1997, 36 mucinous cystadenomas of the pancreas were resected at The Johns Hopkins Hospital. Most of these patients underwent pancreatoduodenectomy or distal pancreatectomy. However, 10 patients (28%) underwent enucleation of their cystic tumor. These 10 patients had a mean age of 63 years, and 6 were men. The cystic lesion was demonstrated by computed tomography in all patients. Enucleation of the cyst was performed in each patient, and four underwent another concomitant abdominal procedure. These 10 patients were followed with periodic computed tomographic scans and clinical examinations.
Enucleation took less time and was associated with less blood loss than resection. Pancreatic fistulas occurred more frequently after enucleation, but the incidence of major complications was similar between the two groups. Follow-up after enucleation averaged 43 months, and none of the patients developed late sequelae or recurrence.
This experience suggests that enucleation of mucinous cystadenomas of the pancreas can be performed safely and that the recurrence rate is low after this procedure. The authors conclude that enucleation is an adequate procedure for benign cystic neoplasms of the pancreas.
本研究旨在确定胰腺黏液性囊腺瘤的手术摘除是否为一种安全且充分的手术方式。
胰腺黏液性囊腺瘤是癌前囊性病变。手术切除是首选的治疗方法，但通常需要进行胰十二指肠切除术或远端胰腺切除术，可选择或不选择脾切除术。尽管目前这些手术的死亡率较低，但仍会出现相当高的并发症发生率，尤其是在胰腺原本正常的患者中。
1990年1月至1997年6月期间，约翰霍普金斯医院对36例胰腺黏液性囊腺瘤进行了切除。这些患者大多接受了胰十二指肠切除术或远端胰腺切除术。然而，10例患者（28%）接受了囊性肿瘤摘除术。这10例患者的平均年龄为63岁，其中6例为男性。所有患者均通过计算机断层扫描显示了囊性病变。对每位患者进行了囊肿摘除术，4例患者同时还进行了另一项腹部手术。对这10例患者进行了定期的计算机断层扫描和临床检查随访。
与切除术相比，摘除术所需时间更短，失血量更少。摘除术后胰瘘的发生频率更高，但两组的主要并发症发生率相似。摘除术后的随访平均为43个月，所有患者均未出现晚期后遗症或复发。
该经验表明，胰腺黏液性囊腺瘤的摘除术可以安全进行，且该手术后复发率较低。作者得出结论，摘除术是治疗胰腺良性囊性肿瘤的一种充分的手术方式。
