Diagnosis and treatment of pancreatic serous cystadenoma / 中国医学科学院学报

<p><b>OBJECTIVE</b>To summarize our experience on the diagnosis and treatment of pancreatic serous cystadenoma.</p><p><b>METHOD</b>Data from 20 patients with pancreatic serous cystadenoma in Peking Union Medical College Hospital from 1994 to 2004 were analyzed retrospectively.</p><p><b>RESULTS</b>Ultrasound test was a good choice for primary diagnosis, while computed tomography scan and endoscopic retrograde cholangiopancreatography (ERCP) were better choice for the suspected cases. Most tumors (60%) were located in the body and tail of pancreas. The distal pancreatectomy was the commonest operation procedure. The main complications were pancreatic leakage (35%). The symptoms were resolved after surgical treatment.</p><p><b>CONCLUSIONS</b>The treatment of pancreatic serous cystadenoma depends on the accurate diagnosis. Ultrasound and computed tomography are useful diagnostic methods. Surgical operation is the treatment of choice. Long-term follow-up has shown satisfactory outcomes if the tumors are resected completely.</p>

The diagnosis and treatment of solid-pseudopapillary tumor of pancreas / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the experience of diagnosis and treatment in solid-pseudopapillary tumor of pancreas (SPT).</p><p><b>METHOD</b>Retrospectively analyzed 12 cases of SPT diagnosed between 2000 August and 2004 February in Peking Union Medical College Hospital.</p><p><b>RESULTS</b>The average age of these 12 cases was 29.1, including 11 women and 1 men. The tumors of 6 cases were located in the pancreatic head, one tumor was in the neck of pancreas and 5 tumors were in the body and tail of pancreas. There were no characteristic clinical manifestations. Solid and solid-cystic masses of low echo were found in pancreas in ultrasonic examinations. CT scan found masses of low density in pancreas, while irregular enhancement appeared in the circumference of all tumors in enhanced CT scan sequences. Tumor markers in patients' serum were all negative. Pancreaticoduodenectomy were performed in 2 cases. Resection of tumors and pancreaticojejunostomy were performed in 3 cases. Simple resection of tumor was performed in 1 case. Segmental pancreatectomy and pancreaticojejunostomy was performed in one patient. Five patients underwent distal pancreatectomy and spleen resection. Ten patients were followed up with the average time of 14.3 months. No evidence of relapses and metastasis in these cases was found.</p><p><b>CONCLUSION</b>Solid-pseudopapillary tumor of pancreas was one of rare pancreatic neoplasm with low malignant potential, affecting primarily young women. Complete resection resulted in long-term survival.</p>

Evaluation and selection of different procedures in the treatment of pancreatic pseudocyst / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the effect of different procedures in the treatment of pancreatic pseudocyst.</p><p><b>METHOD</b>This retrospective review analyzed the outcome of 114 patients with pancreatic pseudocysts managed in PUMC Hospital from January 1990 to March 2002.</p><p><b>RESULT</b>There were 25 patients without intervention, the spontaneous resolution of pseudocysts occurred in 23 of these patients during follow up. Twenty-nine cases underwent CT-guided percutaneous catheter drainage; the effective rate of therapy was 67.85%. Surgical procedures performed in 60 cases and the overall mortality was 5% (3/60). The procedures included external drainage (8 cases) with 1 death (12.5%), excision (13 cases), cyst-duodenostomy (1 cases), cyst-gastrostomy (19 cases) with 7 postoperative gastrointestinal bleeding (36.8%) and 1 death (5.26%), Roux-en-Y cyst-jejunostomy (19 cases) with 3 postoperative gastrointestinal bleeding (15.8%) and 1 death (5.26%).</p><p><b>CONCLUSIONS</b>CT-guided percutaneous catheter drainage has the advantage of minimal invasive and simple technique; it can be as an effective substitute method of traditional open external drainage. Although minimally invasive techniques offer a variety of treatment options, surgical procedures are still indicated for significant number of patients. The incidence of postoperative gastrointestinal bleeding in cyst-gastrostomy was higher than those patients with Roux-en-Y cyst-jejunostomy, but most of them were not difficult to treatment, so cyst-gastrostomy is still a simple and reasonable procedure for selected patients. Excision is a correct choice for cases in which pseudocysts cannot be differentiated from neoplastic cysts.</p>

Combined detection of K-ras mutation and CA 19-9 level in plasma of patients with pancreatic cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To confirm the effect of combined detection of K-ras gene mutation and CA 19-9 level in plasma in the diagnosis of pancreatic carcinoma.</p><p><b>METHODS</b>In 33 patients without pancreatic carcinoma and 15 patients with pancreatic carcinoma, the value of K-ras mutation and CA 19-9 level were examined by enriched polymerase chain reaction (PCR) restriction fragment length polymorphism (RFLP) and radioimmunoassay respectively. The data were analysed with chi(2) test, Fisher's exact test and Kruekal-wall's test. All patients were confirmed pathologically.</p><p><b>RESULTS</b>Eleven of the 15 patients with pancreatic carcinoma and 2 of 10 patients with chronic pancreatitis were found K-ras mutation. CA 19-9 level in patients with pancreatic cancer was significantly higher than that in those with benign disease but with a low specificity. The sensitivity, specificity of combined detection of K-ras gene mutation and CA 19-9 level in the plasma of patients with pancreatic cancer were 66.67% and 97%. There was a significant difference between patients with pancreatic cancer and those without pancreatic cancer. Pathological examination showed atypical hyperplasia in one patient with chronic pancreatitis who had K-ras mutation and higher CA 19-9 level.</p><p><b>CONCLUSIONS</b>Combined detection of K-ras gene mutation and CA 19-9 can be used for adjuvant diagnosis of pancreatic cancer. It is more specific than detection of single K-ras gene mutation or CA 19-9 level in the plasma. The method is complementary to single detection of K-ras gene mutation or CA 19-9 level because it decreases the rate of false-positive diagnosis.</p>