| Aims:The preoperative diagnosis of pancreatic serous cystic neoplasms(SCNs)is still a major problem in the clinical practice.This study intended to analysis its clinical characteristics,image features,treatment and prognosis so that we can have more precise preoperative diagnosis and less uncalled operation and provide clinical guidance for the disease.Methods:The study included a total of 77 cases of pancreatic serous cystic neoplasms confirmed by postoperative pathologic examination.The patients were treated in the First hospital of Zhejiang province from January 2005 to December 2016.General data,clinical feature,radiography,surgical procedures and follow-up results were analyzed retrospectively.Results:Among in the 77 cases of SCNs,64 were female and 13 were male.The median age was 53 years old with age ranged from 22-82 years old.33 patients had clinical feature such as abdominal pain,lumbago and backache,nausea and vomiting,jaundice and so on.Abdominal pain was the most common sympotom.4 patients had a higher CA125 level,5 patients had a higher CA199 level.76 patients took the examination of ultrasound,96.05%patients found the lesions,38.16%patients were diagnosed of cystic neoplasms,no patients were exactly truly diagnosed.69 patients took the examination of computed tomography,98.55%patients found the lesions,52.17%patients were diagnosed of cystic neoplasms,5.80%patients were exactly truly diagnosed.14 patients took the examination of endoscopic ultrasound,100%patients found the lesions,57.14%patients were diagnosed of cystic neoplasms,35.71%patients were truly diagnosed.37 patients took the examination of magnetic resonance imaging,97.3%patients found the lesions,59.46%patients were diagnoses of cystic neoplasms,5.4%patients were truly diagnosed.23 patients took the examination of magnetic resonance cholangiopancreatography,86.95%patients found the lesions,21.74%patients were diagnoses of cystic neoplasms,4.35%patients were truly diagnosed.The rough diagnostic rate was 98.53%by taking the examination of ultrasound and CT.The roughdiagnostic rate was 100%by taking the examination of CT and EUS while the diagnostic rate was 62.5%.The rough diagnostic rate was 85.5%by taking the examination of EUS and MRI while the diagnostic rate was 50%.The rough diagnostic rate was 96.55%by taking the examination of CT and MRI while the diagnostic rate was 10.34%.Of the 77 patients,19 patients underwent pancreaticoduodenectomy,8 patients underwent enucleation,12 patients underwent central pancreatectomy,19 patients underwent distal pancreatectomy include splenectomy,19 patients underwent distal pancreatectomy.There were 56 cases of serous microcystic adenoma,9 cases of serous oligocystic adenoma,9 cases of mixed adenoma,3 cases of solid adenoma.Pancreatic leak or fistula is the most major complication after the operation which occurred in 18 patients.It had no relationship with the operation styles.The patients all recovered after treatment.With the evidence of pathology,the lesions were located in the head of pancreas in 19 patients,in the neck in 16 patients,in the body-tail in 42 patients.63 patients were followed up,the median follow-up period was 39.99 months,4 patients died because of other disease,7 patients suffered diabetes after the operation.No evidence of recurrence or metastasis were foundConclusion:1.SCNs often concealed onset,with no specific clinical manifestations and tumor markers increased,and no manifestations of invasion such as pancreatitis or jaundice.It's most commonly seen in middle-aged women.2.Ultrasound,CT and MRI all have relatively high lesion detection rate.Images under CT and MRI examination have some certain characteristics which lead to high rough diagnostic rate.EUS has a high diagnostic yield.Ultrasound combined with CT yields a high diagnostic rate,while CT or MRI combined with EUS can significantly improve the rough diagnosis rate and the diagnostic rate.We suggest the that ultrasound should be used for lesion detection,CT or MRI should be used for rough diagnose.3.SCNs mostly occur in the body and tail of the pancreas,with mainly microcapsule-based pathological type.It's a kind of benign tumor,and their postoperative recovery is generally good,with very little recurrence or malignant transformation.4.In the terms of treatment,patients that are symptomatic or cannot rule out the possibility of malignant tumor preoperatively call for surgery treatment,other patients should keep following up. |
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