Objective: To analyze the causes of preoperative miscarriage of pancreatic serous cystadenoma (SCN) and find the ways to improve it. Methods: Clinical data of 425 pancreatic cystic neoplasm patients who underwent surgical resection from January 2006 to December 2016 in Department of Pancreatic Surgery in Huashan Hospital were retrospectively analyzed.Excel database was created which covered 128 fields of 7 fields: general information of patients, preoperative blood biochemical indexes, tumor markers, surgical related data, postoperative complications, imaging findings and pathology.One hundred and sixty-one cases of SCN were analyzed in depth, mainly in three aspects: surgical benefit, preoperative imaging diagnostic value and interference factors in preoperative judgement.The classification data were analyzed by χ(2) test and the quantitative data were analyzed by t test.The Logistic regression model was used for multiple factor analysis. Results: Of the 425 PCN cases surgically removed, 161 cases (37.9%) were SCN, the incidence of operative complications was 40.4%(65/161), the hospitalization days was (20.7±12.1)days and the medical cost was (75 267±37 866) yuan.Only 3 of 161 cases of SCN were accurately diagnosed by preoperative imaging methods, 61 cases were diagnosed as "cystic lesions of pancreas" (37.9%) and 52 cases were diagnosed as "pancreatic cystadenoma" (32.3%). SCN was misdiagnosed as MCN(32.3%) and IPMN(28%) before operation.25.5% of them were diagnosed as SCN before operation, but still underwent radical operation.The rate of preoperative imaging diagnosis for identifying SCN was 62.8%.The lack of preoperative endoscopy and the lack of understanding of the image characteristics and biological behavior of SCN were the most important factors affecting the accuracy of preoperative judgment.Statistics found that gender, age, CA125 and tumor location can be used as independent factors contribute to the clinical identification(χ(2)=8.995, P=0.003; χ(2)=10.019, P=0.007; t=3.157, P=0.002; χ(2)=6.790, P=0.009). Logistic analysis showed that women, older than 60 years old, the tumors located in the pancreatic body and tail were the independent factors of SCN classification and diagnosis (OR=0.481, 0.376, 0.577, 0.666, 95% CI: 0.305-0.759, 0.199-0.710, 0.361-0.924, 0.433-1.024, P=0.002, 0.003, 0.022, 0.064). Conclusions: SCN has more benign biological behavior.Although surgical excision is acceptable for clinical safety, the corresponding benefit is very limited.It is possible to improve the rationality of SCN clinical operation decisions to some extent by performing endoscopic examination, imaging doctors to improve the SCN feature recognition and surgeons to enhance the awareness of SCN.
目的： 探讨胰腺浆液性囊腺瘤(SCN)的临床特点和术前误诊原因。 方法： 回顾性分析2006年1月至2016年12月复旦大学附属华山医院胰腺外科收治的425例经病理学检查结果证实的胰腺囊性肿瘤(PCN)手术病例资料并建立数据库，涵盖患者一般信息、术前生化指标、肿瘤标志物、影像学及内镜检查等相关数据、术中资料、术后并发症发生情况和病理学检查结果7个领域128个字段。对其中161例胰腺SCN进行深入分析，重点评价SCN外科手术获益、术前影像诊断价值和干扰术前判断因素。分类数据采用χ(2)检验分析其构成情况；计量数据采用t检验；应用Logistic回归模型进行多因素分析。 结果： 在手术切除的425例PCN病例中，SCN为161例(37.9%)，手术并发症发生率为40.4%(65/161)，住院时间为(20.7±12.1)d，医疗费用为(75 267±37 866)元。161例SCN患者中仅3例术前影像学诊断为SCN，61例(37.9%)被诊断为"胰腺囊性占位"，52例(32.3%)被诊断为"胰腺囊腺瘤"等模糊诊断。SCN在术前多被误诊为胰腺黏液性囊腺瘤(32.3%，52/161)、导管内乳头状黏液样瘤(28.0%，45/161)而行手术治疗，有25.5%(41/161)术前虽诊断为SCN但仍行手术治疗。术前影像学诊断鉴别SCN和非SCN的准确率为62.8%。术前未行内镜检查和对SCN影像特征、生物学行为认识不足是影响术前判断准确性的最大干扰因素。单因素分析结果显示，性别、年龄、血清CA125和肿瘤位置是SCN的独立预后因素(χ(2)＝8.995，P＝0.003；χ(2)＝10.019，P＝0.007；t＝3.157，P＝0.002；χ(2)＝6.790，P＝0.009)。Logistic多因素分析结果显示，在怀疑为胰腺囊性肿瘤患者中，女性、年龄>60岁、肿瘤位于胰体尾为SCN分类鉴别诊断的独立预后因素(OR＝0.481、0.376、0.577、0.666，95% CI：0.305～0.759、0.199～0.710、0.361～0.924、0.433～1.024，P＝0.002、0.003、0.022、0.064)。 结论： SCN多具有良性生物学行为，对其进行手术切除虽然在临床安全性上可以被接受，但获益十分有限。有条件开展内镜检查、影像医师提高对SCN特征的识别能力及外科医师加强对SCN关注和认识可在一定程度上可改善SCN临床手术决策的合理性。.
Keywords: Cystadenoma; Pancreatic neoplasms; Treatment outcome.