Study On Clinical Analysis Of Benign And Malignant Tumors Of The Pancreas

Objective: Pancreatic cancer is a common malignant tumor. It is of highdegree of malignancy and its prognosis is poor. The main clinicalmanifestations are abdominal pain, jaundice, loss of appetite and weight loss.The morbidity age ranges from45to65, and there are more male patients thanfemale. The incidence of this disease increased significantly in recent years.The incidence of pancreatic cancer increases rapidly, which is related withsuch factors as the rising of average life expectancy, the increasing number ofthe elderly people, the improvement of diagnostic techniques and theincreasing of detection rate etc. Pancreatic cancer is developing fast.Pancreatic blood vessels, lymphatic rich and gland bubble without coated, areeasy to make earlier shift. Therefore, upon diagnosis, most of the cancermetastasizes. Benign tumors of the pancreas differs from malignancy, most ofwhich is without invasive growth--even borderline tumors rarely invade thesurrounding organs and vessels; operation excision rate is high; the prognosisis relatively good. Mostly benign tumors have no obvious symptoms, so theytend to be put less emphasis, which causes treatment rate to become low. Withpeople's emphasis of physical health and the improvement of modernexamination method, more and more benign pancreatic tumors have also beenfound, and postoperative pathology confirmed many tumors tend to bemalignant. Therefore, accurate and timely diagnosis before the operation isessential. This paper makes a retrospective analysis of107patients withbenign and malignant pancreatic tumors throughout the last10years, makes aclinical retrospective research of the benign and malignant pancreatic tumorsand provides references for the diagnosis, differential diagnosis and treatmentof the benign and malignant pancreatic tumors.Methods:107patients' data is collected. Those patients, who are in the Second Hospital of Hebei Medical University, have undergone pathologicalobservation by two pathologists and are confirmed that they have benign andmalignant pancreatic tumors from October8,2000to August14,2011. Thedata of those patients is classified into two groups–benign and malignant.There are32patients with pancreatic benign tumors and75with pancreaticcancer. This thesis reviews and analyzes the differences in terms of gender,age, laboratory examination serum bilirubin value, imaging examination,intraoperative exploration respectively through statistical software SPSS13.0data processing, count data by using chi-square criterion, inspectionstandards for P＜0.05.Results:1Pancreatic cancer occurs in the male, the age of onset in common in45-65years old; benign pancreatic tumors occur in the female, the age of onset in45years old the following.2Pancreatic tumors clinical manifestation, the lack of specific clinicalmanifestation. The clinical manifestations of patients with pancreatic cancer inthe most common to abdominal pain, followed by jaundice, angular,abdominal discomfort, etc., and the benign tumors of the pancreas in patientswith clinical performance more than the abdominal pain and abdominaldiscomfort is given priority to, heart palpitations, sweat, insanity, loss ofconsciousness symptoms in patients with benign tumors of the pancreas,special, and part of the patients for medical examination found abdominalmass without obvious clinical features.3Laboratory tests found that serum bilirubin, transaminases to identify thepancreas benign and malignant tumors have a certain value.75cases ofpatients with pancreatic cancer of biochemical examination are47patients(62.7%) in elevated serum bilirubin,28patients (37.3%) to normal; And32pancreas benign tumor patients only3patients (9.4%) appear ictericperformance and the rise of serum bilirubin, another29patients (90.6%) werenormal. In107pancreas benign and malignant tumor by the matching betweenthe chi-square test inspection, prompting the pancreas is malignant tumor in jaundice index whether eleated significant difference (χ~2=25.590, P＜0.05). In47patients with jaundice index increased in patients with pancreatic cancer,aspartate aminotransferase and alanine aminotransferase were increased,whereas patients with benign tumors of the pancreas were observed in1ofaspartate aminotransferase and alanine aminotransferase elevation. Visiblejaundice index increased with aspartate aminotransferase and alanineaminotransferase in patients with elevated tend to diagnosis of pancreaticcancer.4Imaging examination is an important method in diagnosis of pancreatictumors.75cases of patients with pancreatic cancer41cases(54.7%) in theimaging examination showed bravery, pancreatic duct dilatation,42patients(56.0%) occurrence of peripancreatic fat clearance change(disappear,fuzzy or density),53cases(70.7%) tumor size smaller than5cm. In32cases ofbenign tumors of the pancreas in only29patients(90.6%) did not appear inbile, pancreatic duct dilatation,27(84.4%) patients of peripancreatic fatclearance in normal,16cases(50.0%) of patients with tumor size maximumsize＞5cm.In107cases of benign and malignant pancreatic tumor of bravery,pancreatic duct is also expanding, peripancreatic fat clearance is normal,tumor size by unpaired the chi-square test method test, suggestive ofpancreatic malignant and benign tumor in the pancreatic duct bile, whether atthe same time dilation(χ~2=19.004, P <0.05), peripancreatic fat clearancewhether normal existence(χ~2=14.845, P <0.05), tumor size(χ~2=4.183,P=0.049<0.05) there were statistical significance in three aspects. Thebravery, pancreatic duct dilatation, whether at the same time, peripancreaticfat clearance is normal and tumor size as imaging in differentiating pancreatictumor important reference index.5Intraoperative exploration can be more direct in differentiating pancreatictumor nature.75cases of pancreatic cancer patients during exploratorylaparotomy was visible in65patients(86.7%) showed a solid tumor,75cases(100.0%) of all single,51cases(68.0%) appeared around the bloodvessels or tissue invasion,51cases(68.0%) surrounding the lesion appears visible lymph. In32cases of benign tumors of the pancreas patients17cases(53.1%) showed a solid tumor,27cases(84.4%) isolated tumor,6cases(18.8%) appeared the surrounding tissue with vascular invasion,6cases(18.8%) surrounding the lesion appears visible lymph nodes.Intraoperative exploration of the tumor nature (χ~2=14.093, P <0.05), whetherthe tissue around the vascular invasion (χ~2=21.856, P <0.05), whether theappearance of visible lesions of the peripheral lymph nodes (χ~2=21.856, P <0.05) in benign and malignant pancreatic tumor with statistical significance. Anumber of tumors by Fisher exact probability statistical analysis (P=0.002＜0.05) in benign and malignant pancreatic tumors have statistical significance.Conclusion:1Benign and malignant pancreatic tumors in age of onset, gender, laboratorytests serum bilirubin and transaminase change, bile, imaging in pancreatic ductis also expanding, peripancreatic fat clearance is normal, tumor size, tumormature exploration during operation, tumor number, whether visible lesions ofthe peripheral lymph nodes, whether the lesions on the surrounding tissue withvascular invasion there is significant difference.45-65years old male patients,serum bilirubin increase, imaging visible bile, pancreatic duct dilatation,peripancreatic fat fuzzy gap, disappear or density, maximum tumor diameterof less than or equal to5cm, intraoperative exploration of vieible tumor wassolid, solitary, lesions visible around the lymph nodes, lesions of theperipheral vascular tissue invasion, these conditions also appeared inpancreatic cancer possibility is big; at the age of45female patients, serumbilirubin normal, imaging visible bile, pancreatic duct dilatation,peripancreatic fat clearance in normal existence, maximal tumor size＞5cm,intraoperative exploration of visible tumor showed a solid, lesions without thesurrounding lymph nodes, lesions of peripheral vascular tissue withoutviolating the above conditions appear at the same time, the possibility ofbenign tumors of the pancreas.2Pancreatic tumors regardless of benign or malignant are the lack ofspecificity of the clinical manifestations, common symptoms are mainly upper abdominal pain, jaundice, abdominal discomfort, weight loss, fatigue,anorexia, in some cases can cause nausea, vomiting, diarrhea, and some cases,palpitations, sweating, loss of consciousness and other mental disorders,symptoms of low blood sugar in some cases, even a merely physicalexamination found abdominal mass without any clinical manifestation.