超声筛查鉴别胰腺实性假乳头状瘤与胰腺导管腺癌的研究分析

doi:10.16150/j.1671-2870.2022.04.014

摘要/Abstract

摘要：

目的：探讨胰腺实性假乳头状瘤（solid pseudo papillary tumor of the pancreas,SPTP）和胰腺导管腺癌（pancreatic ductal adenocarcinoma,PDAC）的超声表现特征,并比较分析两者之间超声影像要点。方法：回顾性分析2009年8月至2018年3月我院经手术病理证实的48例SPTP患者和48例PDAC患者的超声检查结果,总结其超声声像图特征及两者之间的鉴别要点。结果：以病理检查结果为金标准,超声检查诊断SPTP及PDAC的符合率分别为68.8%（33/48）和85.4%（41/48）。在超声图像上,SPTP的发病部位、内部回声、钙化及肿块内部血流显示情况均与PDAC极为类似（P>0.05）,但SPTP的边缘轮廓清晰率73.9%（34/46）和形态规则率73.9%（34/46）、液化率37.0%（15/42）均明显高于PDAC [28.6%(12/42）、35.7%（15/42）和7.1%（3/42）],而SPTP的主胰管扩张发生率低于PDAC[6.5%（3/46）比35.7%（15/42）],差异均有统计学意义（P<0.01）。上述超声特征中,液化特征鉴别SPTP与PDAC的特异度最高。结论：采用超声对SPTP与PDAC进行初步鉴别具有无创、方便、经济等优点,当超声检查显示胰腺肿块中伴有液化,且边缘清晰、形态规则者,应首先考虑SPTP可能。

关键词: 胰腺实性假乳头状瘤, 胰腺导管腺癌, 超声筛查

Abstract:

Objective: To investigate the ultrasonographic features of solid pseudo papillary tumor of the pancreas (SPTP) and pancreatic ductal adenocarcinoma(PDAC), to initially screen and compare the key points of ultrasonographic diagnosis between the two. Methods: The ultrasound findings of 48 patients with SPTP and 48 patients with PDAC confirmed by surgical pathology in our hospital from August 2009 to March 2018 were retrospectively analyzed. Their ultrasound sonographic features and the key points for differentiation between them were summarized. Results: Using pathological findings as the gold standard, the coincidence rates of the ultrasound diagnosis of SPTP and PDAC was 68.8%(33/48) and 85.4%(41/48), respectively. On ultrasound images, the origin of the mass, internal echogenicity, calcification and internal blood flow were very similar to those of PDAC (P>0.05). However, the rate of clear margins, regular morphology and liquefaction were significantly higher in SPTP than those in PDAC[SPTP, 73.9%(34/46), 73.9%(34/46) and 37.0%(15/42);PDAC, 28.6%(12/42), 35.7%(15/42) and 7.1%（3/42）, whereas the incidence of dilatation of the main pancreatic duct was lower in SPTP than that in PDAC 6.5%(3/46) vs. 35.7%（15/42）, with a statistically significant difference (P<0.01). Among the above ultrasound features, the liquefaction feature was the most significant criterion for identifying SPTP and PDAC. Conclusion: The use of ultrasound screening to identify SPTP and PDAC has the advantages of being non-invasive, convenient and economical. SPTP should be considered first when ultrasound shows a pancreatic mass with liquefaction in a clear margin and regular shape.

Key words: Solid pseudo papillary tumor of the pancreas, Pancreatic ductal adenocarcinoma, Ultrasound screening

中图分类号:

R541.7

顾炫, 柳俊. 超声筛查鉴别胰腺实性假乳头状瘤与胰腺导管腺癌的研究分析[J]. 诊断学理论与实践, 2022, 21(04): 504-508.

GU Xuan, LIU Jun. Ultrasound screening to identify solid pseudopapillary tumours of the pancreas from pancreatic ductal adenocarcinoma[J]. Journal of Diagnostics Concepts & Practice, 2022, 21(04): 504-508.

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组别	胰头部	胰体部	胰尾部
SPTP（n=46）	20（43.5）	10（21.7）	16（34.8）
PDAC（n=42）	26（61.9）	7（16.7）	9（21.4）

超声征象	SPTP（n=46）	PDAC（n=42）	χ²值	P值
边缘轮廓清晰	34（73.9%）	12（28.6%）	18.1	<0.01
形态规则	34（73.9%）	15（35.7%）	13.0	<0.01
内部回声均匀	18（39.1%）	19（45.2%）	0.34	>0.05
伴有液化	17（37.0%）	3（7.1%）	9.48	<0.01
伴有钙化	6（13.0%）	2（4.8%）	0.96	>0.05
检出血流	13（28.3%）	16（38.1%）	0.96	>0.05
伴胰管扩张	3（6.5%）	15（35.7%）	9.77	<0.01