Ji Siqi,Yan Xueqiang,Duan Xufei,et al.Clinical diagnosis and treatment analysis of solid pseudopapillary neoplasm of the pancreas in children[J].Journal of Clinical Pediatric Surgery,2025,(10):963-968.[doi:10.3760/cma.j.cn101785-202410041-011]
儿童胰腺实性假乳头状瘤临床诊治分析
- Title:
- Clinical diagnosis and treatment analysis of solid pseudopapillary neoplasm of the pancreas in children
- Keywords:
- Solid Pseudopapillary Neoplasm of the Pancreas; Diagnosis; Surgical Procedures; Operative; Treatment Outcome; Child
- 摘要:
- 目的 总结儿童胰腺实性假乳头状瘤的诊治经验。方法 回顾性分析2007年7月至2024年1月华中科技大学同济医学院附属武汉儿童医院普外科收治的15例胰腺实性假乳头状瘤患儿临床资料,其中男性4例、女性11例,平均年龄125个月(范围:73~170个月)。以腹痛为首发症状就诊10例,以腹部包块就诊2例,因体检意外发现腹腔内占位性病变2例,因皮肤巩膜黄染就诊1例。肿瘤位于胰头部8例,位于胰腺体尾部7例(其中胰体部2例,胰尾部3例,胰腺体尾部均涉及2例)。收集所有患儿影像学检查数据、手术方案、术后并发症及随访情况。结果 15例中,14例术前CT和MRI提示胰腺实性假乳头状瘤,1例提示胰母细胞瘤。15例均顺利完成手术,其中胰十二指肠切除术4例,保留幽门的胰十二指肠切除术1例,保留十二指肠的胰头切除术2例,肿瘤剜除术3例,胰腺体尾部切除术4例,胰腺体尾部联合脾脏切除术1例。病理结果均确诊为胰腺实性假乳头状瘤。术后并发症包括:4例A级胰瘘,1例A级胰瘘合并低蛋白血症,1例A级胃排空延迟,1例粘连性肠梗阻,1例血小板计数升高,以上均经保守治疗痊愈;1例术后胆瘘患儿经保守治疗无效后予二次手术治愈。15例患儿中2例失访,其余患儿均经门诊或电话随访,无一例肿瘤复发及转移。结论 儿童胰腺实性假乳头状瘤整体预后较好,手术完整切除是主要治疗手段。术式选择应考虑肿瘤位置和肿瘤与胰管及胆管的关系,尽量选择保留胰腺功能的术式,合理采用微创手段减轻创伤,同时术中精细操作以减少术后并发症。
- Abstract:
- Objective To summarize the clinical experience in the diagnosis and treatment of solid pseudopapillary neoplasm of the pancreas in children. Methods A retrospective analysis was conducted on clinical data from 15 pediatric patients with pancreatic solid pseudopapillary neoplasm treated in the Department of General Surgery at Wuhan Children’s Hospital,Tongji Medical College,Huazhong University of Science and Technology,from July 2007 to January 2024.The cohort included 4 boys and 11 girls,with a mean age of 125 months (range:73-170 months).10 patients presented with abdominal pain,2 with an abdominal mass,2 were incidentally diagnosed with an intra-abdominal space-occupying lesion during physical examination,and 1 presented with jaundice.The tumor was located in the pancreatic head in 8 cases and in the body and/or tail of the pancreas in 7 cases (body only in 2 cases,tail only in 3 cases,and both body and tail in 2 cases).Imaging findings,surgical approaches,postoperative complications,and follow-up data were collected and analyzed. Results Preoperative CT and MRI indicated solid pseudopapillary neoplasm in 14 cases,while one case was initially suspected to be pancreatoblastoma.All 15 patients underwent successful surgical resection,including 4 pancreaticoduodenectomies,1 pylorus-preserving pancreaticoduodenectomy,2 pancreas head resections with duodenum preservation,3 tumor enucleations,4 distal pancreatectomies,and 1 distal pancreatectomy with splenectomy.Pathological examination confirmed solid pseudopapillary neoplasm in all cases.Postoperative complications included:4 cases of grade A pancreatic fistula,1 case of grade A fistula with hypoproteinemia,1 case of delayed gastric emptying,1 case of adhesive intestinal obstruction,and 1 case of elevated platelet count,all of which resolved with conservative treatment.One patient developed a postoperative biliary fistula that required reoperation after failed conservative management and was successfully treated.2 patients were lost to follow-up,while the remaining showed no recurrence or metastasis during outpatient or telephone follow-up. Conclusions Solid pseudopapillary neoplasm of the pancreas in children generally has a favorable prognosis.Complete surgical resection is the primary treatment modality.Surgical approach should be selected based on tumor location and its relationship to the pancreatic and bile ducts,with preference given to function-preserving procedures and minimally invasive techniques where appropriate.Meticulous intraoperative management can help reduce postoperative complications.
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备注/Memo
收稿日期:2024-10-17。
基金项目:国家重点研发计划(2022YFC2705000、2022YFC2702002); 武汉儿童医院儿童肝胆胰疾病研究室基金(2022FEYJS004)
通讯作者:闫学强,Email:yanxueqiang@zgwhfe.com