Diagnosis and treatment of space-occupying lesions of the head of pancreas / 中华消化外科杂志

ABSTRACT

Objective To investigate the experiences in the diagnosis and treatment of space-occupying lesions of the head of pancreas.Methods The clinical data of 247 patients with space-occupying lesions of the head of pancreas who were admitted to the First Affiliated Hospital of Chinese Medical University from January 2011 to April 2014 were retrospectively analyzed.All the patients received enhanced computed tomnography and (or) magnetic resonance imaging of the pancreas.The levels of alpha-fetal protein (AFP),CA19-9,CA125 and carcinoembryonic antigen (CEA) were detected,and the serum level of IgG4 was detected in patients who were suspected of autoimmune pancreatitis.Intraoperative pathological examination was applied to patients who were diagnosed as with cancer of the head of pancreas.Pancreaticoduodenectomy,extended pancreaticoduodenectomy or bilio-jejunostomy or (and) gastrointestinal anastomosis were applied to patients according to the stage and infiltration of the tumor.Duodenum-preserving pancreatic head resection or pancreaticoduodenectomy could be selected after informed consent.The adjacent tissues and organs should be preserved on the premise of complete tumor resection for patients with benign and low-grade malignancy.Results A total of 194 patients had solid spaceoccupying lesions of the head of pancreas,including 125 with pancreatic head cancer,45 with mnass in the head of pancreas,9 with chronic pancreatitis with mass in the head of pancreas,11 with autoimmune pancreatitis,4 with insulinoma.Fifty-three patients were with cystic space-occupying lesions,including 12 with mucinous cystadenoma,8 with serous cystadenoma,17 with pancreatic cyst,12 with solid-pseudopapillary tumor of pancreas and 4 with intraductal papillary mucinous neoplasm.The positive rates of AFP,CA19-9,CA125 and CEA of the 71 patients who were confirmed as with pancreatic cancer by pathological examination were 7.0％ (5/71),94.4％ (67/71),42.3％ (30/71) and 0,respectively.The positive rates of AFP,CA19-9,CA125 and CEA of the 12 patients with chronic pancreatitis with mass in the head of pancreas were 1/12,4/12,1/12 and 0,respectively.Seventynine patients with pancreatic head cancer,mass in the head of pancreas and chronic pancreatitis with mass in the head of pancreas received intraoperative pathological examination.A total of 119 patients received operation,including 71 with pancreatic head cancer,7 with chronic pancreatitis with mass in the head of pancreas,4 with insulinoma,1 with pancreatic tuberculosis,8 with mucinous cystadenoma,4 with serous cystadenoma,6 with pancreatic pseudocyst,1 with huge lymphangioma,1 with lymphoepithelial cyst,12 with solid-pseudopapillary tumor of pancreas and 4 with intraductal papillary mucinous neoplasm.Of the 247 patients with space-occupying lesions of the head of pancreas,61 received pancreaticoduodenectomy,4 received duodenum-preserving pancreatic head resection,4 received pancreatic head and neck resection,2 received partial resection of the uncinate process of the pancreas,9 received enucleation of the tumor,38 received bilio-jejunostomy or (and) gastrointestinal anastomosis,22 received endoscopic retrograde cholangio-pancreatography + stent installation,18 received percutaneous transhepatic cholangial drainage + stent installation,1 received exploratory lapartomy and the other 88 patients were untreated.Conclusions The diagnosis and differential diagnosis of the space-occupying lesions of the head of pancreas depend on the clinical presentation,medical history,laboratory examination,sonography,computed tomography or magnetic resonance imaging.Individualized treatment plan based on the feature of the tumor and kinds of the lesions combined with intraoperative pathological examination is helpful for selecting the surgical procedures.